AccountId: 011433970860
ContactId: 8a926c34-cd85-45c5-aefb-305a0e16a245
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 981270 ms
Total Talk Time (AGENT): 275723 ms
Total Talk Time (CUSTOMER): 359831 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/8a926c34-cd85-45c5-aefb-305a0e16a245_20250124T16:59_UTC.wav
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[AGENT][POSITIVE] Good Morning, thanks for calling [PII]. How can I help you?
[CUSTOMER][NEUTRAL] To make sure the money gets to the states that are natural disasters, uh, I can't understand you, ma'am.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Um, yes, I was talking to my insurance plan, and they told me I needed to call you. I have a very complex question. So I don't know if you can answer it, or she said I might have to talk to a supervisor about it. Right now, my husband's getting disability. He pulled his quadricep, and he had to have surgery back in August. Well, he's not getting any better. Um, they did an MRI and found out that he had, he has a meniscus tear in this.
[CUSTOMER][NEUTRAL] Sa knee. So they don't know if that's what's causing the problem for him, for his, uh, knee not, not healing up as fast as we can. So the question I have our disability ends, we got our last payment this month. Now, if the doctor says he still can't go back to work because of this new injury, they found meniscus tear, does that go under another disability claim, or is that considered the same thing?
[AGENT][NEUTRAL] OK, let me go ahead and pull up the policy and I can help you with that. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Um, I don't have that handy. I can look it up real quick if you need me to.
[AGENT][NEUTRAL] Um, what's the last name?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] I just got off the phone with them and she couldn't answer me that, so she told me the best to call you guys.
[AGENT][NEUTRAL] OK. It's his first name spelled [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII], yes.
[AGENT][NEUTRAL] OK, give me a while. I got that list.
[CUSTOMER][NEUTRAL] It's us as a uh.
[AGENT][NEUTRAL] What city in [PII] are you in?
[CUSTOMER][NEUTRAL] [PII]. His social is [PII].
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] And what's your first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] And what's his date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, is he available, um, because we would have to get permission to speak to you since you're not on this policy.
[CUSTOMER][NEUTRAL] Yeah, hold on just a minute. Yeah, they do that every time, so I didn't know, I didn't know, cause I wasn't really asking about money. I didn't know if it mattered about the policy. Hold on.
[CUSTOMER][POSITIVE] in their games and all of the other things that happened and I think you're gonna find it a lot less expensive you'll do it for less than. Hello.
[AGENT][NEUTRAL] Um, yes, is this Mr. [PII]?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] Um, can you verify your name, date of birth, sir?
[CUSTOMER][NEUTRAL] that recommendation
[CUSTOMER][NEUTRAL] Uh, [PII], [PII] uh [PII].
[AGENT][NEUTRAL] Can you verify your address?
[AGENT][NEUTRAL] And lastly, your email address.
[CUSTOMER][NEUTRAL] Uh, well, I got two of them, uh, [PII] or the other one would be [PII].
[AGENT][NEUTRAL] OK, Mr. [PII], thank you for that. Do you give me permission to speak to um your, your wife, [PII]?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] Yes ma'am, yes I do.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] You can go and put it back on online.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thanks ma'am. See the case of the tour and so we definitely record.
[AGENT][NEUTRAL] Um, so you wanted to know, um, since he has a new, um,
[AGENT][NEUTRAL] This new disability if he would, if it would start a new claim and a new um timeline.
[CUSTOMER][NEGATIVE] Well, OK. Well, yeah, because what it is, is we go back to the doctor next week. And cause his knee's not getting any better, um, and they found that he did, he does have a tear, not where they operated or another spot on the same knee. He has a tear, and he's thinking that might been causing any problems to not
[CUSTOMER][NEUTRAL] His knee, his, his knee is not getting any better. That's a, that's a different injury, a different diagnosis, everything, he said. So, I don't know if they're gonna try to repair it because, uh, you know, I don't know if it's something that they go in and repair surgically, or if they, you have to stay off of it, or you have to wear a brace. I don't know. We don't know until we go in, but my question is, if he says his knee from his surgery, which he's on disability right now, is healed up fine.
[CUSTOMER][NEUTRAL] What's causing him the other, the problems right now is that tear. Is that gonna be covered as a new disability? Or does he have to go back to work for a certain time to see if he can work with it, or how, that's what I'm trying to find out.
[CUSTOMER][NEUTRAL] Are you following what I'm saying?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, ma'am. Um, let me put you on a brief hold. I'm gonna ask that question.
[CUSTOMER][NEUTRAL] Yeah, because I looked to the policy, and I can't see anything about that, you know. It just said that if, you know, every, everything is um considered a diagnosis, but if something else is going, but it didn't make it clear. So that's, that's the question I'm trying to find out right now.
[AGENT][NEUTRAL] Yes, ma'am I understand. Give me one second. I'm gonna ask that question.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm doing fine, and yourself?
[AGENT][NEUTRAL] OK, I have a question. So let me give you a policy number. It's 149.
[AGENT][NEUTRAL] 87
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1498778
[AGENT][NEUTRAL] Yeah. OK, I have Ms. [PII] on the phone. So she has a question. So, um, so since he's getting a disability check now, um, she wants to know if he goes to the doctor and they said that he has another.
[AGENT][NEUTRAL] Another sickness other than what he has now, would that start over?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so he would have to go back to work and then if they put him out again, then it'll start over.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Max it up.
[AGENT][NEUTRAL] So he won't get another check after the one you just send out on the [PII]?
[AGENT][NEUTRAL] One more
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you. Bye.
[AGENT][NEUTRAL] OK, Ms. [PII], thank you for holding. So, um,
[AGENT][NEUTRAL] So since he's out of work right now, um, regardless of what the illness is, it's still considered under the same disability. So the only way that another one will possibly start, he would have to go back to work um after they release him to go to work. And then, um, if they put him on again, then that will possibly start up a second month, but we can't continue a second one on this disability um that he's currently on.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Well, I know, but even though it's a different diagnosis.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. So, I mean, OK, so how, how long does he have to go back to work for, for, you know, or like say, they say, OK, try to go back to work and see if he can do it, you know, or whatever. How long does he have to go back before
[CUSTOMER][NEGATIVE] If it don't get any better, he can come back off and say he can't, it's just too painful, they need to fix it. I mean, is it, is it a period of time?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] That I mean, I can't say I mean it's, it's um let me see.
[CUSTOMER][NEUTRAL] Well, I know, but I mean, does he need to go back just for a day or 2 days or a week or 30 days, you know?
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] I'm just saying if I see that and just give me one second.
[CUSTOMER][NEUTRAL] I didn't see it. I didn't see it in there. It didn't state.
[CUSTOMER][NEUTRAL] All it said is if it was a different diagnosis code that he was able to draw, but that's all it said, you know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh let me see um.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] I think it's
[AGENT][NEUTRAL] This plan
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] What the underwriter know? I mean, the person looks at the things when you send it in.
[AGENT][NEUTRAL] Well, I mean, I'm, I'm just going through the policy to see where that section is, um, so that's what I'm reading here, um, to see if I can give you that information.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And the policies are so hard to understand sometimes, you know.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, um, so one thing, um, your husband's gonna have to do as well, um, there's a form that he can send in so that way we don't continue to have to ask permission to speak to you over the phone, um, that way he give you permission.
[CUSTOMER][NEUTRAL] Right, yeah. I thought we used it, I thought we sent that form in a long, long time ago, but maybe it got lost or something. I remember filling it out.
[AGENT][NEUTRAL] Yeah, and um as far as the time frame, um, there's really no time frame that I can give you. The only thing is that if they, if he goes back to work and then the doctor determines that he can't work and puts him back on a disability, it's gonna be a case by case basis.
[AGENT][NEUTRAL] Um, that we have to review to see um if we can um start up another disability time frame.
[CUSTOMER][NEUTRAL] Even if it's a different diagnosis.
[AGENT][NEUTRAL] Yes, ma'am. That is something that we would have to review. We can't just say, well, he can go back for a day.
[CUSTOMER][NEUTRAL] Well, I understand that, but that, that shouldn't, yeah. Well, I understand that. That shouldn't matter if it's a different diagnosis, it should cover it. But I'm, I'm just thinking the worst case scenario. I, I gotta look at all my options here because, you know, we won't have any funds coming in or we gotta figure out what we need to do, you know. And I don't know if it's gonna happen. I'm just saying, you know, worst case scenario, you know.
[AGENT][NEUTRAL] Yes, ma'am. I
[AGENT][NEUTRAL] Yes, now I understand.
[AGENT][NEUTRAL] Yes, ma'am. I, I understand like [PII], we just can't really determine that. I mean, if he goes back in one day and y'all send in another application for a new diagnosis, if it would cover like, so we have to review everything that the do[PII] is saying at that time and then make a determination at that time.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right. Right. OK. Yeah, OK. I, well, I totally understand that. I didn't know if there's a period of time in between or whatever since it would be a new diagnosis code, that's what I didn't know. So, OK. Well, we'll just figure it out when the time comes. Like I said, I don't know for sure if that's what he's gonna do or whatever, but, you know, I was just trying to figure it out.
[AGENT][NEUTRAL] All right, no problem, Ms. [PII]. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Um, what's the form that is it something that I look up online and get the form, or do you send it to us or what?
[AGENT][NEUTRAL] Yes, there's a form online. Let me get you the actual name.
[CUSTOMER][POSITIVE] Yeah, cause I, I can download it, we can get it done.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It's called authorization to disclose, um.
[AGENT][NEUTRAL] Protected PHI um.
[AGENT][NEUTRAL] The authoration to disclose the information.
[CUSTOMER][NEUTRAL] OK. So it's, it's under the form category on the, on the website.
[AGENT][NEUTRAL] Yes, ma'am, and it's, that's the name of the form. It'll say authorized to um, to disclose, authorization to disclose information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] OK. OK. I'll download it. OK. I appreciate your time. Thank you very much.
[AGENT][POSITIVE] No problem, Ms. [PII]. Thanks for calling A. You have a wonderful day.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.