AccountId: 011433970860
ContactId: 77f7c6c6-29fb-4d02-898e-3f6ffd05f89c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676719 ms
Total Talk Time (AGENT): 325382 ms
Total Talk Time (CUSTOMER): 156374 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/77f7c6c6-29fb-4d02-898e-3f6ffd05f89c_20250107T15:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi Ms. [PII], this is [PII] in the care team. I've got um Mr. [PII] on the phone. He wanted to speak to somebody in a higher position about his claim.
[CUSTOMER][NEUTRAL] So his policy number is 250.
[CUSTOMER][NEUTRAL] 675 9.
[CUSTOMER][NEUTRAL] He's calling about claim number 354-4147.
[CUSTOMER][NEUTRAL] And I did read them a remarks to him that the elimination period has been applied.
[CUSTOMER][NEUTRAL] And he wants to talk to somebody else who said he's been trying to get this claim processed for too long.
[AGENT][NEUTRAL] OK, let me get, OK, you can transfer and so.
[AGENT][NEUTRAL] Uh, have we paid him any benefits?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It doesn't look like all of his claims have a D.
[CUSTOMER][NEUTRAL] 1 L
[CUSTOMER][NEUTRAL] Um, remark on them. This last one was the [PII].
[CUSTOMER][NEUTRAL] On the other remarks that he had.
[CUSTOMER][NEUTRAL] Let me look and see what the previous he had um.
[AGENT][NEUTRAL] Elimination period.
[CUSTOMER][NEUTRAL] Claim form was right, the claim form submitted was incomplete. He's had that happen and then he's also had.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That he, based on the effective date, he needed to submit his past medical history.
[AGENT][NEUTRAL] All right. OK. OK, OK, you can transfer him. I'll just pull up all the documents and look and see what we got going. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, Ms. [PII]. Thank you so much. You have a blessed day.
[AGENT][POSITIVE] You're welcome. Thank you, you too.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][POSITIVE] No, this is Mr. [PII].
[AGENT][NEUTRAL] I'm sorry, Mr. [PII]. I apologize. This is [PII] and the benefits department. Uh, give me one minute. I'm gonna review your claim and find out, uh, what's going on with that. So give me just a few minutes, um, while I look at that claim.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] I'm, I'm gonna look at your claim form, see what all we have, and, and let me just give me a few minutes so I can get myself familiar with it. I apologize for any delay.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][POSITIVE] No problem, no problem, because I've been.
[CUSTOMER][NEUTRAL] I've been dealing with this since almost the beginning of December.
[AGENT][NEUTRAL] I understand. Give me just a few more minutes and let me look.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me a few more minutes. I'm going through your file. I'm still reviewing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, now I have found that you had returned to work on [PII].
[AGENT][NEUTRAL] Um, your physician verified your disability from [PII] and for you to return to work on the [PII], but you did, you didn't but you returned to work early on [PII].
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] So based on the information I have is that you have a for a hold on here, give me one minute.
[AGENT][NEUTRAL] Let me pull up that policy and check that.
[CUSTOMER][NEUTRAL] But that was from the visit. My follow-up was on the, on the [PII]. My, my procedure, uh, my surgery was on the [PII], but she did it from the day I went to her for a follow-up from two weeks from there.
[AGENT][NEUTRAL] Pardon
[AGENT][NEUTRAL] OK. Well,
[AGENT][NEUTRAL] We, we don't have any, I, I know that you, you last work on [PII]. We do not have any documentation from a physician verifying disability starting on [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, so, based on the information that we have, um, you return to work before your, um, elimination period ended. So in order for us to provide to review your claim for benefits, um, for the disability beginning on the from the last day that you worked on [PII].
[AGENT][NEUTRAL] We would need a claim form completed by the physician who treated you for on [PII] or [PII], and they would need to verify that you were seeing, did you say you had treatment on the [PII] or [PII]?
[CUSTOMER][NEUTRAL] Yes, I have to, I have emergency surgery in [PII]. I don't live in [PII].
[AGENT][NEUTRAL] OK, well then we will need some sort of, um, did they give you, we need some sort of a, whoever did your surgery, we don't have any disability verified prior to um um November the, I mean prior to [PII].
[AGENT][NEUTRAL] So, in order, we need disability, we need a claim form completed by the physician who can verify disability starting on [PII] and you had, and, and that verifies that you had treatment on the [PII].
[CUSTOMER][NEUTRAL] So what you need like my phone or something?
[CUSTOMER][NEUTRAL] Oh my God, this is.
[AGENT][NEUTRAL] Well, I, I apologize that you have to have documentation that you were disabled and
[CUSTOMER][NEUTRAL] Oh, I, I understand. I, I, I mean.
[AGENT][POSITIVE] And, and I, I really do apologize. I understand your frustration, um.
[CUSTOMER][NEGATIVE] I, I, I just wanna see how can I just cancel the whole policy like this is ridiculous. I mean.
[AGENT][NEUTRAL] Well, you'll have to go through, you'll have to go through the employer or the, the, where you purchased the, the, that we will do, I mean, for any, we do have to have disability verified by the physician who treated you or
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will.
[CUSTOMER][NEGATIVE] I've been doing it, but every time I, I send something in, it's something new every time. It's like literally for the last two weeks. So I just, I'm to the point now, I just find a way to, to get my benefits any other kind of way cause this, this, I never dealt this with a short term ability, honestly.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Well, if we have the proper information, um, with the disability verified, we can review it further. So, but it also needs to indicate that you had treatment on that emergency surgery, um, you know, that date as well.
[CUSTOMER][NEGATIVE] I have my discharge papers from the hospital I went to. I don't like.
[AGENT][NEUTRAL] Well, they would have to verify disability. You might be able, your, your doctor who completed the claim form, verifying disability on the [PII], you may, you may be able to discuss that with them and they can provide it with along with the, the medical not showing that, you know, if your doctor that treated you.
[AGENT][NEUTRAL] To verify disability on [PII], they could complete the claim form verifying you had um treatment, I mean, that you had, you're disabled from [PII] and you could, and then they can verify, you know, they probably have your medical record on file for your emergency treatment and submit that documentation with that claim form to show you had your emergency treatment.
[CUSTOMER][NEUTRAL] So basically I just need to get my medical records from the hospital I had my surgery.
[AGENT][NEUTRAL] Well, you can, yes, but we'll also need a claim form completed by the physician.
[AGENT][NEUTRAL] Verifying disability.
[CUSTOMER][NEUTRAL] Another from the position that I did my surgery.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, if you can get that physician to verify to who did your surgery to complete the claim form, we would not need any medical records from the hospital. If they can if you can get the doctor who did that surgery on [PII], verifying disability and that treatment on [PII], then we can review that.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I would contact the doctor who did that surgery and tell them you need that claim form completed, have them to complete it and tell them they need to make sure that they put down that you have that emergency um surgery on that day and that they need to verify that you're unable to work from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'll make note of our conversation so that when the examiner gets that they know that we contact you, you, you spoke to us.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, now I have to give you the disclaimer. This call is just a verification of what is needed. It's not a guarantee and benefits until we get all the proper information reviewed and received and reviewed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, Mr. [PII], is there anything else I can help you with right now?
[CUSTOMER][NEGATIVE] Not at all.
[AGENT][POSITIVE] OK, well, uh, Mr. [PII], you have a wonderful day and thank you for calling American Public Line.