AccountId: 011433970860
ContactId: 6ad08f2c-2d05-4951-a9f8-2780a5e9b917
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2233159 ms
Total Talk Time (AGENT): 662499 ms
Total Talk Time (CUSTOMER): 1259545 ms
Interruptions: 12
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/6ad08f2c-2d05-4951-a9f8-2780a5e9b917_20250107T18:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I believe I am a member of APL. I signed up for short-term disability at work, and they really didn't tell me much about it. And I just looked on you guys up off of like my pay stub that I was putting into. So is it possible to look me up?
[AGENT][NEUTRAL] OK, Ms. [PII], so you're wanting to see if you have a policy that's active with APL, is that correct?
[CUSTOMER][MIXED] Yeah, I know I pay into some short short term disability, but they, I just had to Google like 5 star and then you guys came up.
[AGENT][POSITIVE] OK, yes, ma'am. Well, I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And um
[AGENT][NEUTRAL] So you don't have a policy number, is that correct?
[CUSTOMER][NEUTRAL] I've, so no, I've never, like they really didn't give me much information at all. I was doing, you know, benefits and whatnot, and they were like, do you wanna add on short term disability?
[CUSTOMER][NEUTRAL] And I was like, yeah, sure. And um
[CUSTOMER][NEUTRAL] Then I don't know, but it also might be under [PII] because I got married too.
[AGENT][NEUTRAL] And who do you work for, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, every public schools in [PII].
[AGENT][NEUTRAL] OK, so one moment, please. And um what is your full social so I can see if we have a policy?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Yes I am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Let me see if I can locate your information that way and if not, we'll go about a different way. So just one moment.
[CUSTOMER][POSITIVE] Thank, thank you, yeah.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I believe I have located a policy for you, um,
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So first off, I will need to verify several things with you first, for security purposes, and then we'll go from there, OK? So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] Um, I think it's under my where I live now, [PII].
[AGENT][NEUTRAL] OK. Is there an apartment number? Oh, well, first off, what's your zip code?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Uh, uh, our apartment number is [PII] and our zip is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you and then the last thing to verify is going to be your email address this does appear to be your work email.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] And what is that?
[CUSTOMER][NEUTRAL] Oh sorry it's uh [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you so much. So, yes, ma'am, we do have two policies for you. Now, is your married name [PII] or married name [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so we do have your policies under [PII].
[CUSTOMER][POSITIVE] Oh good perfect.
[AGENT][NEUTRAL] And you do have two policies it shows in our system and it shows that it's a term life policy, and then there you do, yes, also have a short term disability policy. Now, we have a portal for our members, Ms. [PII]. It's called the online service center. I can give you both of your policy numbers, but I can also email you the user guide for how to set up your profile in the portal which gives you access to.
[AGENT][NEUTRAL] Both of your policies.
[AGENT][NEUTRAL] Which has, I mean, your
[CUSTOMER][NEUTRAL] So I, so I think I know what you're talking about. Actually I do know what you're talking about. It just wasn't letting me um log on because I was using my personal email by accident.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh, that's OK. So it is very secure. When it says secured, it is very secure. So, you would need to use [PII] as the last name.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then yes, you will have to use your work email address unless you want me to change that. I can change it to a personal it's just, but yes, whichever one we have on file is the one you will have to use to set it up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, the
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, and then um.
[CUSTOMER][NEUTRAL] I had a couple of questions about the short term disability. Would I talk to you about it?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You can certainly try. I can certainly try and help you with that, and any information status on benefits would be a verification of benefits and not a guarantee of payment. So, yes, ma'am. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So, um, I was talking to my HR from work and like, so pretty much.
[CUSTOMER][NEUTRAL] Yeah, I picked up short-term disability, whatever my policy says. And then um after that, a while after, maybe like a year after that, almost a year, I found out that I'm pregnant. So then I was, we don't um
[CUSTOMER][NEUTRAL] As like teachers in [PII], we don't get a paid FMLA. We get unpaid. So that's why I want to pick up the short-term disability, um, for time off. So my question was for that, for your short-term disability in regarding pregnancy, how many days does a person get?
[AGENT][NEUTRAL] OK, so let's see on this.
[AGENT][NEUTRAL] Policy, so just a moment.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Um, let me double check one thing.
[AGENT][NEUTRAL] I'm looking through some of your policy information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Me and my friend, well, my colleague were working yesterday and I like just didn't want to get cause she saw 180 days and I was like, that seems very long. I'm like, I'm gonna call them.
[AGENT][NEUTRAL] That is correct, but there's some additional verbiage that I'm looking for, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so on your policy, yes, ma'am, there is the
[AGENT][NEUTRAL] You've been max I wasn't quite ready to be where I needed to be. OK, so the maximum disability benefit period per injury and or for sickness is 180 days.
[AGENT][NEUTRAL] You do have an elimination period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of 7 days. So that means you would have to have, that means that it would, you would have to be off.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] For 7 days before this would start.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It would start after you have been all 7 days.
[CUSTOMER][NEUTRAL] Can I ask you a follow up question with that?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we
[CUSTOMER][NEUTRAL] Prior to like switching to you guys the APL prior to that our other short term disability with Affleck. Now, my friend didn't pick it up because
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] They told her, um, with, with Aflac, I want to see if your policy was different that um.
[CUSTOMER][NEUTRAL] If she, so pretty much my due date is [PII], right? And we get out of school during that time. Now, do I have to use my short term disability?
[CUSTOMER][NEUTRAL] The day I have the baby, or can I hold on to it till after the summer? Like, for instance, like, could I wait to use it or do I have to use it the day that the baby is born?
[AGENT][NEUTRAL] OK, to my, uh, it does, but this is not, this would be for the period of time that you're off from which your doctor has you medically off of, of work. That would be, because there's a section of the form that you have to complete.
[CUSTOMER][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] Your employer has to complete and your physician has to complete. And they have to put when you're out of work and your return date to work. And then each and, each month you have to submit your portion if you're gonna be off, you know, more than a month because benefits are reviewed and paid on the [PII] of each month if benefits are payable.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but, you know, all three parties have to submit their own piece of that.
[CUSTOMER][NEUTRAL] Uh, so,
[CUSTOMER][NEUTRAL] So, for example, if
[CUSTOMER][NEUTRAL] I, I'm just trying to figure this out so I know like I don't wanna be shocked if anything happens. So I get the summers off from work and I get paid. I come back, I start my 3 months of um.
[CUSTOMER][NEUTRAL] Maternity leave. Now,
[CUSTOMER][NEGATIVE] After that 3 months or whatever, the time that I'm, the time that I get paid, once I stopped getting paid, and if the doctor said I'm not ready to go back to work, like if, God forbid something happened, that's when the short term disability would kick in.
[AGENT][NEUTRAL] So, OK.
[AGENT][NEUTRAL] Let's go through that scenario again to make sure I understood what you said. So you had a a routine delivery. There were no complications, you're off on your medical leave for work and then you, uh-huh, for your maternity leave, and then you develop a complication.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Maternity leave.
[CUSTOMER][NEUTRAL] Yes, with the short term disability then work, or is the short term disability is like I'm out of luck, the short term disability would not cover.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Any, it's OK, if it would just have to be reviewed again, we can't pay claims over the phone, it would have to be reviewed for, you know, uh determination based on the medical information that is received.
[CUSTOMER][NEUTRAL] So it's like, you would go through the doctor, the doctor would write whatever and then submit it to the short-term disability.
[AGENT][NEUTRAL] Yes, there's a section that you will have to complete, your employer has to complete, and your physician who has to complete.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] For it to be reviewed.
[CUSTOMER][NEUTRAL] And now,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So with the maternity leave with our school.
[CUSTOMER][NEUTRAL] We get 1 month 100% paid and then the next two months are 50% paid. I asked um my HR and they didn't know the answer to it. They said you would have to contact your short term disability. Does would short term disability cover the remaining percent that I'm not getting?
[AGENT][NEUTRAL] OK, one moment. Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, I'm just looking. I'm reading some additional information.
[CUSTOMER][POSITIVE] Oh yeah, no, I appreciate it.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so this, I'm actually not 100% sure on because I don't review this type of claim. I'm strictly just trying to look at your policy information. So, you said that you're paid for maternity leave the first month is 100% paid, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] And then for your next 2 months that you're off, you get 50% of your salary.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Per month, is that correct? OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I'm probably going to need to
[AGENT][NEUTRAL] I was gonna try to not have to do this to connect you with one of the examiners who reviews this type of claim.
[AGENT][NEUTRAL] To verify that with you because I'm just not 100% sure on how to answer that question.
[CUSTOMER][POSITIVE] Oh yeah, no, that's totally fine I appreciate it.
[AGENT][NEUTRAL] Yes, absolutely, but when I do connect you over, um, and I may stay on the line if that's OK with you, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, this is just one of the newer policies that I'm not as familiar with reviewing and I don't easily see the answer to that, so that's why I'm saying I don't wanna give you any, um.
[AGENT][NEGATIVE] Incorrect.
[AGENT][NEUTRAL] Information
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] But you won't have to reverify any of your information and I will give them your policy number. If you would like, I can give you the policy number for your disability policy. I can actually give you both of them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so your disability policy is 2500.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 376.
[CUSTOMER][NEUTRAL] 276
[AGENT][NEUTRAL] Uh-huh, and then the life policy is 249-8.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] 184.
[CUSTOMER][POSITIVE] 184. Thank you.
[AGENT][POSITIVE] Mhm. You're very welcome. So if you need any help in setting up that portal now that you know which email address you need to use, um, you can just give us a call back and we'll be happy to help you with that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, well, you're very welcome. So again, is there anything else in the Das I can help you with first?
[CUSTOMER][NEUTRAL] No, I think that's it.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO and I hope that you have a really nice afternoon.
[CUSTOMER][POSITIVE] Thanks, you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you. So one moment, please.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][NEUTRAL] You for calling APL. This is [PII]. With whom am I speaking to? How may I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you today? Oh, happy [PII]. Mhm. I've been sick since this joker started.
[CUSTOMER][POSITIVE] I'm good and you? Happy [PII].
[CUSTOMER][NEGATIVE] I see you're sick. Uh-huh.
[CUSTOMER][NEUTRAL] Oh Lord, OK.
[AGENT][NEUTRAL] Uh, so I have an insured that I have asked if it would be OK if I stayed on the line. Um.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is one of the um
[AGENT][NEUTRAL] The City of Everett, Massachusetts members and it's on a disability policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The policy number is 2500376 for Miss [PII].
[CUSTOMER][NEUTRAL] OK, let me get it pulled up. Mhm.
[AGENT][NEUTRAL] OK. Yeah. And I'll just, she's fully verified. And she's calling to find out about how the disability plan would work along with pregnancy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So I feel like I confidently answered most of her questions. But then she asked me if, um,
[AGENT][NEUTRAL] She said that they receive 1 month of being off work at a 100% payment.
[AGENT][NEUTRAL] And then they received the next 2 months that they're out 50% of their salary. So she was asking.
[CUSTOMER][NEUTRAL] And where where where are you getting all this information from, from just her?
[AGENT][NEUTRAL] And from her, uh-huh, from her employee, uh-huh.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Oh, I have to pull, let me pull up her, uh, disability, uh, policy and see. I've never, I, I have not seen one. I can't.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, yeah, cause that is from her employer, that's.
[AGENT][NEUTRAL] Yeah, that has nothing to do with her policy. Yeah, that has nothing to do with this policy. Mm mm.
[CUSTOMER][NEUTRAL] Yeah, with us so uh oh that's not coming up. I must have wrote something down wrong. Tell me that number, yeah.
[AGENT][NEUTRAL] 2500376.
[CUSTOMER][NEUTRAL] It's a. That's not coming up.
[CUSTOMER][NEUTRAL] 25 0 sorry it was me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII], OK, and this looks like a new policy first off, and let's see here. Let me check, uh, uh, OK, preexisting is gonna apply.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] There's no takeover information. Yep, there's no takeover information listed. I don't see any listed and this is her disability policy.
[AGENT][NEUTRAL] It is.
[AGENT][POSITIVE] Great.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] She's never had one prior. Uh, uh-huh.
[AGENT][NEUTRAL] Hold on, preexisting.
[AGENT][NEUTRAL] Under exclusions
[CUSTOMER][NEUTRAL] Um, well, we just know where to go look at on, um, we go according to the effective date. A policy has to be, a policy has to be in effect for one year for it not to be subject to that, yeah, so.
[AGENT][NEUTRAL] What do you
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] Yup, and I didn't, yup, and I didn't tell her. Yeah.
[AGENT][NEUTRAL] Yup, and I didn't tell her. Mhm. I did not, I didn't go over that with her.
[CUSTOMER][NEUTRAL] So I just automatically, uh, this is something I automatically know cause I process claims. And when I look at that, that's something that I have to look at. And then I go to the screen where the takeover information is listed and I see there is none for Ms. [PII].
[AGENT][NEUTRAL] God
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, I'm gonna ask that we get a lot of training. mm.
[CUSTOMER][NEUTRAL] Yeah, so let's see, let me take a look though because I wanna, before you send her over.
[AGENT][NEUTRAL] Cause this policy just, it wouldn't affect you. Yeah, I'm gonna stay on the line though.
[CUSTOMER][NEUTRAL] Cause I don't, yeah, cause I don't know.
[AGENT][NEUTRAL] And so, I mean, I had just gone over and get, first of all, she's like her friend told her that there was 180 days, you know, blah blah and I, and she didn't believe that.
[AGENT][NEUTRAL] And I said, well, that is the max benefit period, um, you know, and I just explained the waiting period, with the the elimination the
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Elimination period is [PII] couldn't come up with the term. You know, that's 7 days that she would have to be off for 7, work 7 days before this, she would be eligible for this. Um, we did not get into the benefit amounts.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I was like, you know, what she signed up for or anything. We haven't done that. And then she went into that other about would
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Would what she's getting from her employer effect.
[AGENT][NEUTRAL] You know, how her payment, if she was eligible.
[AGENT][NEGATIVE] For her disability and I, I looked and I try to find that in the policy and I just, I, I couldn't. I just couldn't.
[CUSTOMER][NEUTRAL] Oh, yeah. That was quite, quite a bit, quite a bit. Um.
[AGENT][NEGATIVE] I, I, I can't. We need more training on all this to be able to do all this for them.
[CUSTOMER][NEUTRAL] Let's see, waiver of premium.
[CUSTOMER][NEUTRAL] Yeah, and, and sometimes still, see, I'm trying to get to no disability benefit will be payable if the disability is caused by or resulting from pre-existing physicians blah blah blah blah. OK, yep, pre-existing appliance is in here. OK, so, uh, you could send her over and um I'm just gonna.
[AGENT][NEUTRAL] Yeah. And I'm gonna let her know, yeah, and I'll just tell her that, um, you know, I'll, I'll just join in the call.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, stay on the line, yeah, just stay, stay in the background.
[AGENT][POSITIVE] Thank you so much, but let me get Miss [PII]. She's real nice. So hold on just a minute, [PII], and thank you very much. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] Thank you. All right. Mhm.
[AGENT][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hey, this is still [PII], and I have [PII], who is one of our examiners on the line. [PII], can you hear Ms. [PII]?
[CUSTOMER][POSITIVE] Yes, I can. Yes, how are you today? Mhm.
[AGENT][NEUTRAL] OK. And Ms. [PII], yes, Ms. [PII], [PII] is gonna go ahead and take over and she's gonna further assist you, OK?
[CUSTOMER][POSITIVE] Awesome thank you so much.
[AGENT][POSITIVE] You are certainly very welcome. And again, it was nice speaking with you today.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Alright, Mr. [PII], so I understand your name, date of birth, email, and physical address has been verified, correct?
[CUSTOMER][NEUTRAL] Yes. And you're calling in because you have some questions regarding your uh disability policy um now just if you could please just give me a recap um I know we we're gonna discuss uh how long it um last the disability period. I know you wanted that question answered and then was there a question regarding pregnancy or maternity?
[CUSTOMER][NEUTRAL] Yeah, so she seemed to answer a few of those. She did, so she did say uh.
[CUSTOMER][NEUTRAL] The short-term disability is 180 days. Obviously, she said like you have to provide a doctor's note and then send it and then it has to be approved, all that stuff was, um, obviously I knew, but um,
[CUSTOMER][NEUTRAL] Our work, previously our work, we had no maternity leave, so, um, about like a year ago, I picked up short-term disability just in case I ever needed it.
[CUSTOMER][NEUTRAL] But then throughout throughout the time um we got a new contract and our new contract is giving us maternity leave, but they're giving us 1 month at 100% and then they're giving us the next two months at 50%.
[CUSTOMER][NEUTRAL] So I was talking to my human resources um department about it and they said to me they're like I was like can I supplement that 50 with my sick time or my short term disability? She said she was uh she was I.
[CUSTOMER][NEUTRAL] Just answered the sick time on behalf of us she goes I can't answer that question about short term disability you have to call them. So that's what I was wondering. OK, so let me, let me, what I can address is what your policy covers for APL. I can't address anything that your HR said we're gonna pay you this. We're gonna pay you 50% with that I cannot assist you with. I can assist you with what this policy says it will consider for you.
[CUSTOMER][NEUTRAL] So give me one moment. I'm trying to pull up uh the disability claim form because uh you will need to send fill that out as well and there is some information now that now are you expecting is this for maternity leave?
[CUSTOMER][NEUTRAL] Yes, but not until June. I just like to get my, um, just like to know what's going on. I don't wanna leave it until the last minute.
[CUSTOMER][NEUTRAL] So June, uh, what day are you doing June?
[CUSTOMER][NEUTRAL] Uh, they say about [PII]? OK, alright, OK, and then the only reason of [PII], OK, now the reason I'm, I'm asking that question is, um, I'm gonna assist you with, you know, your, your questions uh answers to the questions that you, um, asked us to provide to you today. Now verification of coverage does not guarantee the payment of a claim. First off, this is a disability policy, short term.
[CUSTOMER][NEUTRAL] It will cover only up to 180 days, OK? Uh, it is subject to preexisting, so this policy has an effective date of [PII]. That means until the policy is in effect for an entire year, which in this case it would have to be [PII] for preexisting not to apply. In this case it looks like preexisting is going to apply, OK?
[CUSTOMER][NEUTRAL] And that's just something that when you fill out your your initial disability claim form which is found online at the [PII] on the claims and forms, page one gives you detailed instructions on what you need to submit.
[CUSTOMER][NEUTRAL] OK, and what the doctor needs to fill up a little bit.
[CUSTOMER][NEUTRAL] What's, what's, what's confusing.
[CUSTOMER][NEUTRAL] OK, thank you. So what's confusing to me is.
[CUSTOMER][NEUTRAL] I signed up for the short term disability, right? Not pregnant.
[CUSTOMER][NEUTRAL] So then, how is that preexisting?
[CUSTOMER][NEUTRAL] And do you have a copy of your policy certificate?
[CUSTOMER][NEUTRAL] Uh, I assume the policy certificate. Yes, if you create an online service on account, you will be able to download that information. I'm gonna read the information in there that tells you about the preexisting limitation. It says no disability benefit will be payable if a disability is caused by or resulting from a pre-existing condition and begins before you have continuously been covered under the policy for 12 months. So it's just like I previously said in the beginning.
[CUSTOMER][NEGATIVE] Unfortunately, uh, that follows up on the preexisting.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Now are you pretty much saying like the short term disability will not work for my pregnancy? I'm not saying that we don't process claims over the phone. I'm just making you aware of what the policy states as far as limitations and what coverage is.
[CUSTOMER][NEUTRAL] I don't like for people to be surprised. Your policy is less than one year old that applies to everybody, anybody that has a policy with APL, with its disability, whether it's uh medical gap insurance, whether it's cancer policy, whether it's accidents, so forth and so on, if you're not effective for one year, then preexisting applies, OK? And we don't, we don't process claims over the phone so I cannot tell you, oh, we're gonna deny your claims because you were preexisting. that's something that once you file that claim.
[CUSTOMER][NEUTRAL] The uh processor that's assigned that claim will advise you of the information that is additionally needed.
[CUSTOMER][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] I just like
[CUSTOMER][NEGATIVE] Confused because
[CUSTOMER][NEUTRAL] If it's like um like you said, if it's not gonna.
[CUSTOMER][NEUTRAL] If I needed to be the policy for a year, right, what is the point of filing the claims if it's.
[CUSTOMER][NEUTRAL] Under the year mark.
[CUSTOMER][NEUTRAL] That's just a decision that you would have to make, ma'am, because again, you may be covered, you may not. That's not some that that's something that we wouldn't know until you file the claim and all the information is reviewed at that time.
[CUSTOMER][NEUTRAL] OK, alright. Mhm.
[CUSTOMER][NEUTRAL] And did you have another question about the benefit amount? Did you have a question about that?
[CUSTOMER][NEUTRAL] Um, well, I still want that question about if you guys cover the remaining amount that the employees that the employer doesn't pay.
[CUSTOMER][NEUTRAL] The only amount that this policy is gonna cover is the amount that's listed in your policy certificate, and for you it says your disability benefit will be $4000 not to exceed 60% of your monthly payment if it's approved.
[CUSTOMER][NEUTRAL] And anything and anything in addition to that we, that's something that you have to take up with your employer. We're APL you have an APL short term disability policy and that's what I'm assisting you with today, those benefits for APL and that's what you're benefit, correct, but so what I'm asking you is that which has nothing to do with my employer's HR so.
[CUSTOMER][NEGATIVE] My employer's HR specifically told me to reach out to you guys because they obviously like don't know my policy and everything.
[CUSTOMER][NEUTRAL] They're saying, hey, for the 2 months that you get for 2 months um after the [PII], you will get 50% of your pay.
[CUSTOMER][NEUTRAL] What I'm asking APL insurance is what the APL short term disability is would APL then cover the other 50% because again it's not it's not 60% or more than my pay, but would they.
[CUSTOMER][NEUTRAL] Mhm. Can you do your, can you do your maternity leave, which was 50% along with a short term disability if it doesn't exceed the 60% of the short term disability. The only benefit that you will have from APL is your disability benefit will be $4000 and that's exceeds 60% of your monthly compensation. That's what your policy certificate states. That's the information we have for you at APL.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] I guess it's just like not that clear to me because obviously you get short term disability when you're out of work, right? And you're out of work and you're not being paid.
[CUSTOMER][NEUTRAL] But if you're getting paid by your employer, just not the full amount, can you also use your short term disability?
[CUSTOMER][NEUTRAL] You'll have to file your disability claim. You will have to answer the questions that's asking you about any other compensation you may be receiving. Once they receive your claim, they will review it and process it accordingly.
[CUSTOMER][NEUTRAL] That's not anything that we can process and answer over the phone either.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I guess like why can't any of these questions be answered over the phone? Why is it so um like.
[CUSTOMER][NEGATIVE] Secretive. Why is it like I have secretive. We're, it's not secretive. We're telling you that your disability benefit is $4000 not to exceed 60% of your monthly compensation. That's what we're supposed to tell you.
[CUSTOMER][NEGATIVE] We can't, you're telling me hypothetically, allegedly I'm gonna receive 50% of this and it's not hypothetical or it's not even if it's even if it's true even if it's true we don't process any claim without documentation in front of us, OK? So until it's in front of us, it's not processing a claim.
[CUSTOMER][NEUTRAL] I, I have no claim right now. I, I'm not even, I'm not on short term disability right now. I'm, I'm trying to get questions.
[CUSTOMER][NEUTRAL] Answered and everything is very secretive.
[CUSTOMER][NEUTRAL] OK, well, I'm sorry you feel that way. If you wanna pull your policy certificate or if you need me to mail it to you, I can. Uh, the, the information we have, that's your, that's gonna be your benefit, that's gonna be your disability payment.
[CUSTOMER][NEGATIVE] We have no other information in that other than when it's time for you to file. I don't know why you guys just it's just interesting to me I just don't know why you guys don't have any more information besides like OK so like pretty much like.
[CUSTOMER][NEUTRAL] In my view, what's the point of customer service if all I am told to do is go read a packet, right? That's pretty much it's like I can do that on my own. I'm looking for someone that has knowledge and is intelligent with the short-term disability, and can help me with basic questions. And I understand that you don't want to miss say anything.
[CUSTOMER][NEUTRAL] But also, there's, there needs to be some sort of help.
[CUSTOMER][NEUTRAL] And I will let you know that on section D of the claim form, it tells you sources of income. The section specifically instructs you to complete details with other sources of income, which is what you're mentioning, OK? And it goes on this claim form for it to be considered processed at the time it is received. It's not anything that again we can plug in and tell you this is it. We have to have documentation.
[CUSTOMER][NEUTRAL] It has to be filled out signed by your employer.
[CUSTOMER][NEUTRAL] Signed by your doctor?
[CUSTOMER][POSITIVE] Correct, correct. But the woman on the phone previously, she was so much more helpful and gave me like yes or no answers to questions and she specifically
[CUSTOMER][NEGATIVE] Connected me to you because she said actually she was, I don't know the answer to that, and I don't want to give you the wrong answer, so I'm gonna send you to someone who processes these claims, and you just don't seem like you know what you're talking about. You just seem like you're reading from a script.
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][NEUTRAL] Do, it's a very like simple thing like, do people.
[CUSTOMER][NEUTRAL] Or does your company ever match or not match, I should say, but ever also do short term disability along with partial pay from an employer.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] One other thing.
[CUSTOMER][NEUTRAL] Miss [PII], I'm gonna have someone return a call to you becaus[PII] I've already given you all the information that we have, um, and, and if it, if you would like for someone else to relay the same information to you, I will have someone to recall return your call. What is a good number to call you back at?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK, and is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Just a phone call back from someone else please. OK, thank you for calling ATL Miss [PII] you have an awesome rest of your day and take care.
[CUSTOMER][POSITIVE] Thank you so much bye bye bye.