AccountId: 011433970860
ContactId: 6fa24df3-8b07-48a9-b934-993f6e2d63cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1169680 ms
Total Talk Time (AGENT): 570032 ms
Total Talk Time (CUSTOMER): 610984 ms
Interruptions: 17
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/6fa24df3-8b07-48a9-b934-993f6e2d63cc_20250107T19:04_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII] with whom am I speaking to? How may I help you?
[CUSTOMER][POSITIVE] Hey, [PII], it's [PII]. How are you today? Oh, happy [PII]. Mhm. I've been sick since this Joker started.
[AGENT][POSITIVE] I'm good and you? [PII].
[AGENT][NEGATIVE] I see you're sick. Uh-huh.
[AGENT][NEUTRAL] Oh [PII], OK.
[CUSTOMER][NEUTRAL] Uh, so I have an insured that I have asked if it would be OK if I stayed on the line, um.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is one of the um.
[CUSTOMER][NEUTRAL] The City of Everett, Massachusetts members and it's on a disability policy.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The policy number is 2500376 for Miss [PII].
[AGENT][NEUTRAL] OK. Let me get it pulled up. Mhm.
[CUSTOMER][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.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So I feel like I confidently answered most of her questions. But then she asked me if um
[CUSTOMER][NEUTRAL] She said that they receive 1 month of being off work at 100% payment.
[CUSTOMER][NEUTRAL] And then they received the next 2 months that they're out, 50% of their salary. So she was asking,
[AGENT][NEUTRAL] And where, where, where are you getting all this information from? From just her?
[CUSTOMER][NEUTRAL] Then from her, uh-huh, from her employee, uh-huh.
[AGENT][NEUTRAL] OK. OK.
[AGENT][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.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, cause that is from her employer, that's.
[CUSTOMER][NEUTRAL] Yeah, that has nothing to do with her policy. Yeah, that has nothing to do with this policy. Mmm.
[AGENT][NEGATIVE] Yeah, with us, so, uh oh, that's not coming up. I must have wrote something down wrong. Tell me that number, yeah.
[CUSTOMER][NEUTRAL] 2500376
[AGENT][NEGATIVE] So that's not coming up.
[AGENT][NEUTRAL] 25 0 sorry it was me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, [PII], OK. And this looks like a new policy first off, and let's see here. Let me check, uh, uh, OK, pre-existing is gonna apply.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] There's no takeover information. Yeah, there's no takeover information listed. I don't see any listed and this is her disability policy.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] She's never had one prior. Uh.
[CUSTOMER][NEUTRAL] Hold on, preexisting.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Under exclusions
[AGENT][NEUTRAL] Um, well, we just know what 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.
[CUSTOMER][NEUTRAL] What do you
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yup, and I didn't, yup, and I didn't tell her. Yeah.
[CUSTOMER][NEUTRAL] Yeah, and I didn't tell her. Mhm. I did not, I didn't go over that with her.
[AGENT][NEUTRAL] For it not to be subject to that, yeah, so.
[AGENT][NEUTRAL] So I just automatically uh this is something I automatically know because 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].
[CUSTOMER][NEUTRAL] God
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna ask that we get a lot of training. Mhm mm.
[AGENT][NEUTRAL] Yeah, so let's see, let me take a look though because I wanna before you send her over.
[CUSTOMER][NEUTRAL] Because this policy just it went into effect, yeah, I'm gonna stay on the line though.
[AGENT][NEUTRAL] Cause I don't, yeah, cause I don't know.
[CUSTOMER][NEUTRAL] And so, I mean, I had just gone over and get, first of all, she's like, you know, her friend told her that there was 180 days, you know, blah blah, and I, and she didn't believe that.
[AGENT][NEUTRAL] Uh-huh, uh-huh.
[CUSTOMER][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
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can't think 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.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][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
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would what she's getting from her employer effect.
[CUSTOMER][NEUTRAL] You know how her payment if she was eligible.
[CUSTOMER][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.
[AGENT][NEUTRAL] Oh, yeah. That was quite, quite a bit, quite a bit. Um.
[CUSTOMER][NEGATIVE] I, I, I can't. We need more training on all this to be able to do all this for them.
[AGENT][NEUTRAL] Let's see, waiver of premium.
[AGENT][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 physician, blah blah blah blah. OK, yep, pre-existing appliance it's in here. OK, so, uh, you could send her over and um I'm just gonna.
[CUSTOMER][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.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, stay on the line. Yeah, just stay, stay in the background.
[CUSTOMER][POSITIVE] Thank you so much, but let me get Miss [PII]. She's so nice. So hold on just a minute, [PII], and thank you very much. OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. All right.
[AGENT][POSITIVE] Thank you. All right. Mhm.
[CUSTOMER][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] Hi, hey, this is still [PII], and I have [PII] who is one of our examiners on the line. [PII], can you hear Ms. [PII]?
[AGENT][POSITIVE] Yes, I can. Yes, how are you today? Mhm.
[CUSTOMER][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. You are certainly very welcome. And again, it was nice speaking with you today.
[CUSTOMER][POSITIVE] You too, yes ma'am, thank you.
[AGENT][NEUTRAL] All right, Mr. [PII], so I understand your name, date of birth, email, and physical address has been verified, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 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] Mhm.
[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, which, 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%.
[AGENT][NEUTRAL] Mhm.
[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 can just answer 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.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. 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%, we're gonna that I cannot assist you with. I can assist you with what this policy says it will consider for you. So give me one moment. I'm trying to pull up uh the disability claim form because uh you will need to fill fill that out as well.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is some information now that, now are you expecting, is this for maternity leave?
[CUSTOMER][NEUTRAL] OK.
[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.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So, June, uh, what day are you doing in June?
[CUSTOMER][NEUTRAL] Uh, they say about [PII].
[AGENT][NEUTRAL] 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] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It will cover only up to 180 days, OK? Uh, it is subject to preexisting.
[AGENT][NEUTRAL] So this policy has an effective date of [PII].
[AGENT][NEUTRAL] That means until the policy is in effect for an entire year, which in this case it would have to be [PII] for pre-existing not to apply. In this case it looks like preexisting is going to apply, OK? 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.
[AGENT][NEUTRAL] Page one gives you detailed instructions on what you need to submit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what the doctor needs to fill out?
[CUSTOMER][NEUTRAL] OK, that confuses me a little bit.
[AGENT][NEUTRAL] Mhm.
[AGENT][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?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a copy of your policy certificate?
[CUSTOMER][NEUTRAL] Uh, I assume it's online, right?
[AGENT][NEUTRAL] 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, unfortunately.
[AGENT][NEUTRAL] 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?
[AGENT][NEUTRAL] We, 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. 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 this disability, whether it's uh medical gap insurance, whether it's cancer policy, whether there's accidents, so forth and so on.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] 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, the uh processor that's signed that claim will advise you of the information that is additionally needed.
[CUSTOMER][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm 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 [PII].
[AGENT][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.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][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.
[AGENT][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, 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.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Co so correct, correct, but so what I'm asking you is that which has nothing to do with my employer's HR so.
[AGENT][NEUTRAL] And that's what your benefit is.
[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 it would 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.
[AGENT][NEUTRAL] And, and the
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] 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?
[AGENT][NEUTRAL] The only benefit that you will have from APL is your disability benefit will be $4000 not to exceed 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?
[AGENT][NEUTRAL] You will 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] Yeah.
[AGENT][NEUTRAL] That's not anything that we can process and answer over the phone either.
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I guess like why can't any of these questions be answered over the phone? Why is it so uh like.
[CUSTOMER][NEUTRAL] Secretive. Why is it like I have to wait?
[AGENT][NEGATIVE] Because it's not, it's not 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. We can't, you're telling me hypothetically, allegedly, I'm gonna receive 50% of this and ma'am, we don't, we, we.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No, it's not hypothetical or it's not hypothetical or alleged.
[AGENT][NEUTRAL] Well, 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.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it's not, it's not processing, it's not processing a claim. 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.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Right, right, absolutely. Mhm.
[CUSTOMER][NEUTRAL] Answered and everything is very secretive.
[AGENT][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][NEUTRAL] Everything's very.
[AGENT][NEUTRAL] We have no other information in that other than when it's time for you to file, you will.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I just 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 wanna miss say anything.
[CUSTOMER][NEUTRAL] But also, there's, there needs to be some sort of help.
[AGENT][NEUTRAL] And I will let you know that on section D of the claim form, it tells you sources of income. This 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.
[AGENT][NEUTRAL] It has to be filled out signed by your employer.
[AGENT][NEUTRAL] Signed by your doctor.
[CUSTOMER][NEUTRAL] So
[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
[AGENT][NEUTRAL] Mhm.
[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.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Let's see here. Let me take a look at one other thing.
[AGENT][NEUTRAL] Miss [PII], I'm gonna have someone return a call to you because 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.
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Just a phone call back from someone else, please.
[AGENT][POSITIVE] 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.
[AGENT][NEUTRAL] Bye bye.