AccountId: 011433970860
ContactId: 6c1ba861-ec4d-4168-ab3b-118d0289ae29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1000210 ms
Total Talk Time (AGENT): 398707 ms
Total Talk Time (CUSTOMER): 420347 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/6c1ba861-ec4d-4168-ab3b-118d0289ae29_20250214T21:17_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Yeah, hi [PII], um, my name is um [PII], and I do the group's administration and I work for the broker's office.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And and I needed to.
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] Well, I've been helping a lady with her claim. Um, I've uploaded the claim and stuff and I just need to, um, I think she got partial payment today, um.
[CUSTOMER][POSITIVE] And, and which is great.
[CUSTOMER][NEUTRAL] And I just wanted to clarify when the next payment could be expected.
[AGENT][NEUTRAL] OK, so you're trying to check claim status for a member [PII], is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you. And what is the callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Um, that is 230-1502.
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get her information pulled up and then I'm gonna need to verify a couple of things um related to the group and also for her for security purposes. So give me just a moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so first off, [PII], uh, what group is she with?
[CUSTOMER][NEUTRAL] S P J S T Rest Home Inc.
[AGENT][NEUTRAL] OK, thank you. And then who is the agent of record for this group?
[CUSTOMER][NEUTRAL] Uh, it should be [PII]. that's in process of being changed to me, but I don't think that's happened yet.
[AGENT][NEUTRAL] OK, um, and then what is your email, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and it's [PII], is that correct?
[CUSTOMER][NEUTRAL] No, no, it's [PII]
[AGENT][NEUTRAL] And your last name again, how was the correct spelling of?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah [PII]
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] And, OK, thank you. And you said it was [PII] let me say that again, [PII].
[CUSTOMER][NEUTRAL] [PII] yeah.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] No, no, no, it's [PII], I don't know, it's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir, that's what I have. OK.
[AGENT][NEUTRAL] OK, so do you mind letting me place you on a brief hold because yes sir I don't have you listed as the agent on this group.
[CUSTOMER][NEUTRAL] Yeah, I work in the broker's office. I'm, I'm also listed as under the group's administrative contact.
[AGENT][NEUTRAL] OK, and then.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and [PII], if you could please verify the insured's name and date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] And date of birth.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hang on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I skipped off that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] OK, thank you so much. Alright, so just a moment for me to get the claims information pulled up.
[AGENT][NEUTRAL] OK, so currently the policy paid to the date of 25. I can see that we have spoken with Ms. [PII] and she was sent some additional forms for the physician to complete since she has not returned to work.
[AGENT][NEUTRAL] So as of now, the policy is paid to 25, sorry, 25.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, OK, so I, I, um, I, I don't know how you sent those forms to her because she didn't, I, I talked to her, I don't know when you sent them to her when you talk to her, she, she, she's.
[AGENT][NEUTRAL] They've been faxed twice today. They've been faxed to the number that she's given twice. She, they were faxed um by one of the examiners earlier today and then I actually spoke to her just a little while ago.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I received a confirmation that the fax was successfully sent.
[AGENT][POSITIVE] It was delivered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So somebody told me that these forms would be on the website, but I, I don't guess that's quite true.
[AGENT][NEUTRAL] Well, the short term disability claim form, yes, it is on the, it is on the website.
[CUSTOMER][NEUTRAL] No, I'm talking about the forms y'all send.
[AGENT][NEUTRAL] You can
[AGENT][NEUTRAL] And we sent her the disability claim form. That's the form that was sent to be completed.
[CUSTOMER][NEUTRAL] I'm talking about
[CUSTOMER][NEUTRAL] Right, so
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh the physician?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so I'm sorry, maybe we're talking over each other here. So, so I'm looking on the website right now and all I can see are the two original things that I that I put up there on her behalf on [PII]. At, at some point I was told that when if you all send out new, new information requests that it would show up on the website. Is that not did I misunderstand that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, well, if it's related to a claim, yes, you would see it on the screen you're looking at. When we fax them.
[CUSTOMER][NEUTRAL] OK, so you just said you just said that y'all submitted new I'm sorry, so you just said you submitted new you sent new forms, that's not showing up on the website. I can't see it.
[AGENT][NEUTRAL] That is correct, because the fax is not going to show up. That is correct. This is what you can see is related to claims, to a claim that is processed or in processing.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] When we fax claim forms, no, that's not gonna show up in the portal.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so, alright, so here's, I guess my problem. I, I don't see you, you just stated that y'all need additional information to continue the payment. Is that what I understood?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, I don't see that information on I don't see that request on the website. How how do you all make that request?
[AGENT][POSITIVE] That, that is correct, yes.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] That is sent to when the explanation of benefits, that's part of the information that's included that's mailed with the remarks because all of those, all of the remarks are on page 2 of each explanation of benefits associated with that claim, and it shows the pay to date and the examiner would send the forms, but because she's still not at home, she asked that we fax what the physician needed to complete and so that is what we did.
[CUSTOMER][NEUTRAL] OK, OK, uh, well, I was led to believe that the explanation of benefits would be put online, but I guess that's not true.
[AGENT][NEUTRAL] Um, the, if you can see the claim number, you can see the explanation of benefits.
[AGENT][NEUTRAL] Can you see that? Mhm. And if you
[CUSTOMER][NEUTRAL] I can see the claim number, but I, I can see the claim number but I cannot.
[CUSTOMER][NEUTRAL] See explanation of benefit. I can only see the direct.
[AGENT][NEUTRAL] OK, did you click, did, yes, sir, did you click on the claim number?
[CUSTOMER][NEUTRAL] I'm clicking on the claim number right now. There's nothing behind that claim number. Maybe I'm not in the right place. I'm um I'm under my employees under the group side.
[AGENT][NEUTRAL] OK, so you may not be able to see it from there.
[AGENT][NEUTRAL] Yes, because this would be specific to her and her information under her profile, not overall as for the group.
[CUSTOMER][NEGATIVE] OK, OK, so that's where I was misled. Yeah, she's not home. She's in the hospital. I don't think she's really got much help.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And so, um, and, and, and then.
[AGENT][NEUTRAL] Oh, yeah.
[AGENT][POSITIVE] Real sweet lady.
[CUSTOMER][MIXED] She, she is very sweet, but we're not serving her.
[CUSTOMER][NEUTRAL] So maybe maybe she solved it all on her own today, which would be great. I don't have to be involved, but um, I, I just need to, uh, I, you know, she, if she doesn't, if she doesn't get what she needs, she starts calling the employer and that makes us all look bad, right? Yeah, and, and so, uh, and so you and then, um, OK, so, so y'all paid through [PII], that's how you came up with $600 and something dollars.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, sure.
[AGENT][NEUTRAL] That is, yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] Um, and then y'all needed additional information and, and, and how is that gonna go going forward? I don't know how much longer she's gonna be in rehab, but you know, like the, the form that was submitted stated pretty clearly that, you know, it's gonna be at least a couple of months before she regains function nor normal function.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] So, and if the doctor extend when they complete their form, if they extend her return to work date beyond what they have initially sent to us or even this time when the doctor puts a new date on there, if the disability goes beyond that point, then they would have to send that in. Each month, she has to send in the claimant's statement.
[AGENT][NEUTRAL] But if the return to work date changes, that's when the physician and the employer have to also complete their sections and submit it to us, showing that she is still out.
[AGENT][NEUTRAL] With a new return to work date.
[CUSTOMER][NEUTRAL] OK, and, and I, I think that's what the problem is, is like I don't really understand what you just said and I know she doesn't.
[AGENT][NEUTRAL] I'm sorry. Well, OK, so initially, if her doctor, yeah, if her
[CUSTOMER][NEUTRAL] So let's, let's slow down. Let's slow down real slow here, OK, so I'm looking at the form page 7. I'm looking at page 7.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And it says date first treated condition, [PII], and date of most recent treatment, [PII], uh, frequency of treatment other hospitalized. The patient is still under care date of next appointment, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The patient, OK, and, and so is that, is that what and then date disability begin [PII].
[CUSTOMER][NEUTRAL] Um, is this the, OK, so is this the form that has to be updated by the physician or is it another form?
[AGENT][NEUTRAL] It's the same form. That's the physician statement that you're looking at?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. And that's.
[CUSTOMER][NEUTRAL] Yeah, they just again so now the, the, they didn't fill out.
[CUSTOMER][NEUTRAL] Extent of disability date disability began.
[CUSTOMER][NEUTRAL] And it says actual or anticipated return to work date and they didn't fill that out, but then it does say in how many months do you expect a fundamental change in the patient's conditions that it says 2.
[CUSTOMER][NEUTRAL] Um, OK, so you need, so, so, so that form, is that what's and maybe it's best if you, if I can just get access to the EOB or, uh, she doesn't understand this stuff and and and like.
[AGENT][NEUTRAL] Now, we, yes, sir, we can only provide, uh, I'm sorry, we can't provide that to you, not her explanation of benefits.
[CUSTOMER][NEUTRAL] Um, OK, so she didn't have anybody else to help her. So are we gonna help her or are we gonna confuse her? Because if she gets confused, she's gonna start calling the employer and we all look bad. OK. Um, and she needs her money, obviously, right? Everybody needs money.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And yeah, and so, so what, what do I need to do to be authorized to represent her?
[AGENT][NEUTRAL] She would need to complete one of the third-party authorization forms.
[CUSTOMER][NEUTRAL] OK, um, and where is that form?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Let me look at the forms on the website. I do not believe that that one is on there. Let me check that for you.
[AGENT][NEUTRAL] And we would
[CUSTOMER][NEUTRAL] There's an authorization to disclose information out there.
[AGENT][NEUTRAL] That is what I'm looking for, but my, my.
[AGENT][NEGATIVE] System is still trying to load the, the forms.
[CUSTOMER][NEUTRAL] Yeah, I see that.
[CUSTOMER][NEUTRAL] Second item.
[AGENT][NEUTRAL] So you do, did you, you did find it?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that's the one that she would need to complete and return to us.
[CUSTOMER][NEUTRAL] OK, and I can load that up on the website?
[AGENT][NEUTRAL] You said that you located it?
[CUSTOMER][NEUTRAL] Yeah, no, I've located the forms so I can load that up on the website once I have her completed.
[AGENT][NEUTRAL] Yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, and then y'all need another position statement is that what I've also understood?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And then and then you're also saying that you need what else do you need that that comes in that that that she needs to fill out for the next payment?
[AGENT][NEUTRAL] She monthly has to complete the insured statement for each month of disability.
[CUSTOMER][NEUTRAL] OK, is that on the website?
[AGENT][NEUTRAL] That's part of that entire claim form, the disability claim form, the insured statement, employer section, and the physician statement are all in the, in one claim form. So yes, sir.
[CUSTOMER][NEUTRAL] OK, OK, let me, let me put my eyes on the exact pages you need then, so you need pages.
[CUSTOMER][NEUTRAL] So you need, you need page 1 and page 2.
[CUSTOMER][NEUTRAL] Completed every month.
[AGENT][NEUTRAL] The insured statement. Mhm.
[CUSTOMER][NEUTRAL] OK, uh, please tell me which pages that is.
[AGENT][NEUTRAL] OK, let me pull the form up. I'm sorry, one moment.
[CUSTOMER][POSITIVE] That would be wonderful, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, on the disability claim form, the statement of the insured is pages 1 and 2, and she will make sure she signs it. She will need to make sure she signs it and dates it.
[CUSTOMER][NEUTRAL] Oh, signatures, the signature page is on page 3, I guess it's 12, and 3.
[AGENT][NEUTRAL] One is all instructions. Page 1 is nothing but instructions. It's one of 8. That's all the instructions for what needs to be done, how to complete the form, each section, uh-huh, and by whom.
[CUSTOMER][NEUTRAL] OK, page 23.
[AGENT][NEUTRAL] So, on page 2.
[AGENT][NEUTRAL] Of 8, it states it has disability claim form at the top and it says statement of insured and that continues on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Through page 3.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] Well, you are certainly very welcome. So is there anything else, [PII], that I can help you with this afternoon?
[CUSTOMER][POSITIVE] Uh, no, I think that's it. Well, apparently that's all you can do because I would like to see that my put my eyes on the EOB because that that's what I think I need to be able to do so I can help her properly.
[AGENT][NEUTRAL] OK. Well, as soon as we can get that released.
[AGENT][NEGATIVE] Received back and processed.
[AGENT][NEUTRAL] Then we can do that.
[CUSTOMER][POSITIVE] OK wonderful thank you so much.
[AGENT][POSITIVE] OK, well, you are certainly very welcome and again, thank you for calling APL and I hope you have a great rest of your day and a nice weekend.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Great. Oh thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.