AccountId: 011433970860
ContactId: 5663653e-de62-4e80-9b3c-ba136c386e23
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442920 ms
Total Talk Time (AGENT): 182825 ms
Total Talk Time (CUSTOMER): 263984 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/5663653e-de62-4e80-9b3c-ba136c386e23_20250217T20:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, young lady. My name is [PII], and I have some questions um regarding my um claim.
[AGENT][NEUTRAL] OK, and what is your policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, can I give you my social? I never have that thing ready when I call you guys. I'm sorry about that.
[AGENT][NEUTRAL] No, you're fine. Give me one moment. OK, and what's your social?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And let's see. And Mr. [PII], uh, verify your date of birth, mailing address, and email address, please.
[CUSTOMER][NEUTRAL] OK, that would be uh [PII]. Email would be [PII]. Uh, my address would be [PII].
[AGENT][NEUTRAL] OK. And you say you're calling to verify the claim status?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, give me a moment.
[AGENT][NEUTRAL] I do show a claim processed on the [PII], last Friday, and so uh payment was sent out today via direct deposit in the amount of 3900.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, this is my question. Um, I failed to get my doctor, uh, to send his form in on time, so, uh, basically I was supposed to get 2 months of payment this month and it and it it I, I get $3000 a month, but anyway, come out to 3900 and I'm kind of wondering, um, what's going on because it should have been 6, and I was wondering if you could let me because I know I'm getting I'm just now getting my surgery done and uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And my benefits are about to stop because I'm sure it only goes for, for 12 months, so I'm getting pretty close to that, but I was wondering why uh why it was 3900.
[AGENT][NEUTRAL] OK, it looks like they paid 3000 for the month of, give me one moment.
[AGENT][NEUTRAL] Um, looks like they paid 3000 for the month of January and looks like from [PII], that's where that 900 comes from.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, must have been on paperwork that is that your return to work date?
[CUSTOMER][NEUTRAL] I'm not sure what the doctor put on there because um uh I don't see how it could be because the surgery is coming up uh this week and um then there's 6 weeks of therapy so I don't think he would have put, put an end date on it as far as like this, you know, this month.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] But if you did, I could always correct that, have him, you know, or see if he'll correct it for me or I mean it's up to the doctor no matter what, but I mean I could at least bring it to his attention, but.
[CUSTOMER][NEUTRAL] So basically the 900 comes from uh being just a partial payment of this month of February.
[AGENT][NEUTRAL] Uh, correct. And also when they process the claim and send out that EOB they also send out a claim form that you would need to complete, uh, a continuing disability claim form.
[CUSTOMER][NEUTRAL] Right, right, right, so I have to do another one of those.
[AGENT][NEUTRAL] Yes, sir, and I'm looking at the claim and it looks like they have uh anticipated return to work date of [PII]. So you can contact that provider. Um, let me see if they need the provider's portion of the phone as well. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you man. That's, you know what, every time I call APL and, and I've done it quite a bit and I hate to hassle you guys, but you guys, everyone I've spoke to up there, man, has has been just totally awesome with me and patient and, and, uh, you know, it's, yeah, you guys are great.
[AGENT][POSITIVE] Oh, thank you.
[AGENT][POSITIVE] Oh, thank you. It's always good to hear. Sometimes we get yelled at, but um,
[CUSTOMER][NEUTRAL] No doubt.
[AGENT][NEUTRAL] Which I understand, but um when they just process that claim, they, when they send out the EOB they also send out a claim form. You just need to fill out your portion and your doctor fill out their portion of the form and um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, OK.
[AGENT][NEUTRAL] Usually if it's submitted around the [PII] of, uh, before the [PII] of each month, that's when, uh, any continuing claims are paid. So let's say you can get that to us before the [PII], there shouldn't be a delay. Yeah.
[CUSTOMER][NEUTRAL] We just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Right.
[CUSTOMER][NEUTRAL] OK, and you guys were doing the best you could buy at least giving me a partial when you could have just said hey hold up we'll just do it all at once and so I mean you guys really looked out for me on that so but uh OK I'll get with the doctor and see what see what's going on with him, get him to send another form in and then I'll send my form in um and um yeah, and everything should now when's my last my last uh benefit uh payment?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Is it in April?
[AGENT][NEUTRAL] Well, it depends on what the doctor writes on the form of when you should return back to work because they have a different date of [PII] is a return anticipated return to work. So once they send us that information showing that you will be out a little bit longer, then the examiner will determine how much longer you have.
[CUSTOMER][NEUTRAL] And it was you have to like.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, but what my question was, is, um, no matter what, um, it only goes to 12 months, so I was just wondering when my 12 months, um, uh, when I reached the end of my benefits.
[AGENT][NEUTRAL] Well, it can exceed over 12 months, so, um,
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] OK, I see, I see what you're saying.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK, well, let me get on my end of it because you guys certainly are taking care of your end of it. So let, let me get on my shot with a new one.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well you probably hadn't received the form yet. It was sent out today. Um, you can't, I don't know if you want to go to our website, but you can, uh, print out that claim form, and we just feel like, like I said, fill out your portion and your physician fill out there.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][POSITIVE] OK, I'll get right on that and uh I'll tell you what it's, it's a big relief because uh I am just dying to get back to work, man, and uh, you know, because I'm trying, I'm, I mean you guys are helping, but I mean I'm trying to live off like less than 25% of my normal income and it's it's not easy, man, and then I hurt myself playing on a swing set with my granddaughter and but thank [PII] I had, I was smart enough to get the insurance in the beginning anyway, but.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] So, I mean, I'm not.
[AGENT][POSITIVE] It does help, but it's you being, well, I know when I was on this bill but not being able to work and get bored, it's like, OK, I'm ready to go back. I'm ready to get this started.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] That's right I'll tell you, man, my family is stuck with me too, man, and I'll tell you that's you, you could say you got all the friends in the world, but when it comes down to it, man, it's family, you know what I'm saying? And uh, but, uh, look, you've been, you've been great and I appreciate you and I'll get on, I'll get on my end of it and uh get this thing going.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Alright, well, thank you for calling APL, Mr. [PII]. You have a great day.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][POSITIVE] You do as well. Bye bye.
[AGENT][NEUTRAL] Alright bye.
[CUSTOMER][NEUTRAL] So it was supposed to be direct deposit today.