AccountId: 011433970860
ContactId: 909003ff-e853-49d5-95aa-55823a08cc6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1723520 ms
Total Talk Time (AGENT): 487430 ms
Total Talk Time (CUSTOMER): 291395 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/909003ff-e853-49d5-95aa-55823a08cc6d_20250311T18:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I had a couple questions please about the um disability.
[AGENT][POSITIVE] OK, I'm happy to help. Uh, is it your personal policy that you're calling on?
[CUSTOMER][NEUTRAL] Well, I'm calling for my husband, but he added me on there. He's sent in the authorization to speak with me.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I just need the policy number if you have that, please.
[CUSTOMER][NEUTRAL] It's 02117201.
[AGENT][NEUTRAL] Alright, let me pull this up here. Give me just a moment.
[AGENT][NEUTRAL] And if I can get the name and date of birth, please, on the policy?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and then I'll need to verify please the address on file and email.
[CUSTOMER][NEUTRAL] Yes, uh, address is [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And I don't know what his email address is.
[AGENT][NEUTRAL] Looks like we have [PII]. Do you know if that's still good?
[CUSTOMER][MIXED] Yeah, that's still good. I just don't know about how.
[AGENT][POSITIVE] OK. Uh, how can I help today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me, um, we're not sure how long the doctor's gonna have him off. I just wanna know how long with the policy. I know it's 6 months, but can you tell me how much longer we have until the 6 months expires?
[AGENT][NEUTRAL] Oh, as far as how long you've been receiving, let's see.
[AGENT][NEUTRAL] Uh, OK. One moment.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] OK, so right now for this year, I'm showing a payment. Well, I saw one for December or for January and then for February. I'm just going back and looking at what's been paid out here.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] The first payment that I see there was one for 76 of 24 that was just like a small partial payment and then the next claim it looks like um.
[AGENT][NEUTRAL] The payment started it looks like in September.
[AGENT][NEUTRAL] Does that sound right to you?
[CUSTOMER][NEUTRAL] Uh, then he went back to work in September.
[CUSTOMER][NEUTRAL] For 10 days.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because then I see [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then the next payment wasn't until January.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, it looks like there was.
[AGENT][NEUTRAL] A payment for September and then part of October and then there wasn't any sort of benefits paid out again until January of this year.
[CUSTOMER][NEUTRAL] Yeah, right, but
[CUSTOMER][NEUTRAL] Can you tell me, uh, so we
[CUSTOMER][NEUTRAL] What was January for? What month was, I was trying to look on the, the notice, but I couldn't really understand what it was, what the benefits was for.
[AGENT][NEUTRAL] I don't know, let me see what the.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So it's for January and February.
[AGENT][NEUTRAL] Yeah, and I'm gonna, I'm pulling up this policy really quickly on another screen.
[AGENT][POSITIVE] I think that'll help me.
[AGENT][NEUTRAL] Compare dates here a little better. Give me just a second.
[CUSTOMER][POSITIVE] I think we got something, we got something for December.
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] There was a benefit payment it looks like for [PII] through the end of the month, so that was a partial payment for January and it was a benefit of $500 and then the next claim following that that I see.
[AGENT][NEUTRAL] Uh, was just for the rest of February or January and then the full month of February, so I don't see that anything else has been paid out thus far. So if 6 months is the full limit on the benefits, then I'm showing January as the first payment out for this year.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Looking here it says [PII], it says $0.
[CUSTOMER][NEUTRAL] But he was
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEGATIVE] I don't understand why he didn't get paid because it was still consecutive because
[AGENT][NEUTRAL] Let me see what it says here.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] Benefits of
[CUSTOMER][NEGATIVE] I know they took $900 back.
[AGENT][NEUTRAL] Uh, it says benefits applied to overpayment of claim.
[AGENT][NEUTRAL] Any payable benefit on the dates of treatment were applied to an overpayment on a previous claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it wasn't it doesn't look like it, they're not saying that he wasn't eligible for those dates. It's not a denial in that sense.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that makes sense. She did tell me about that, that they were gonna request $900 back because they overpaid him for 10 days that he worked.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like that's what that, that code was on that. So, um, it wasn't that, yeah, he wasn't eligible for the date.
[CUSTOMER][NEUTRAL] OK, did y'all take anything out besides the 900?
[CUSTOMER][NEUTRAL] Cause the benefits they said was 4100.
[CUSTOMER][NEUTRAL] Um, they took 900 back.
[CUSTOMER][NEUTRAL] The correct benefits, OK, should have been 3200. OK, and.
[CUSTOMER][NEGATIVE] Do y'all, she said I called the uh insurance where we we received it from, she said after 90 days it should be um waived when you're not working.
[AGENT][NEUTRAL] Um, as far as the premium?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm looking in the policy to see what I see about the premium. Let me see.
[AGENT][NEUTRAL] OK, so it does say if you become disabled due to a covered injury or sickness and are eligible to receive disability payment, your insurance will be continued without payment of premium. Waiver of premium will begin the first month of the following. A, you complete the elimination period, 90 days of continuous disability, whichever is latter.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] The I mean the company that he worked for, she said that he, he's already paid up.
[CUSTOMER][POSITIVE] But she said that we should get those benefits back because he's been
[CUSTOMER][NEUTRAL] Disabled for, I know it's been 90 days now, cause it started in December.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I talked to the lady that sold us the policy, and that's what she was telling me.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEGATIVE] Well, I talked to a representative. The person who sold us the policy, he, he died.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I talked to the company.
[CUSTOMER][NEUTRAL] Do you show a payment um in December?
[AGENT][NEUTRAL] Um, for towards the policy or like a benefit payment to to you guys?
[CUSTOMER][NEUTRAL] Up, up to us.
[AGENT][NEUTRAL] I did not see one in the claims, no. Um, so I went through the most 3 recent ones on his policy.
[AGENT][NEUTRAL] And it shows the elimination period um in January, it shows from the [PII] and then that benefit payment, but prior to that, the claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] There was a payment for the September and then October.
[AGENT][NEUTRAL] And it included the elimination period beginning in August, but I don't see anything between.
[AGENT][NEUTRAL] The October and January.
[AGENT][NEGATIVE] So if he returned.
[CUSTOMER][NEUTRAL] Well, he, he went back to work. He went back to, he tried to go back to work in, in December, so he did work in some a little bit in December and had to
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So if
[CUSTOMER][NEUTRAL] So that, that, that it restarted.
[AGENT][NEUTRAL] If, if he did a, yeah, if he did a return to work, then the waiver of premium would restart for the 90 days.
[CUSTOMER][NEUTRAL] OK, which
[CUSTOMER][NEUTRAL] The last day he worked was [PII].
[CUSTOMER][NEUTRAL] So it's, isn't it 90 days almost? Yeah.
[AGENT][NEUTRAL] In a few weeks, it would be considered, yeah, um, towards the end of March.
[CUSTOMER][NEUTRAL] So how do, how do I, do I just call back?
[AGENT][NEUTRAL] Um, if you want, yeah, if you wanna double check on that, you can definitely call us back. Um, let's see.
[CUSTOMER][NEUTRAL] Well she already already spoke to the insurance people.
[CUSTOMER][NEUTRAL] Uh, uh, recently just got off the phone with him is how, um.
[CUSTOMER][NEUTRAL] She educated me about it.
[CUSTOMER][NEUTRAL] I didn't even know about it until she told me.
[AGENT][NEUTRAL] OK, so let me see. I'm sure that we'll send something out once that would take effect, but let me double check on that and just see. You said his last day was in December, correct? worked?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Around the [PII], you think?
[CUSTOMER][NEUTRAL] Um, I believe so.
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] I can have him check his his records to make sure if you like.
[AGENT][NEUTRAL] Let me just see what the next steps are um.
[AGENT][NEUTRAL] In doing that, um, on the policy, [PII], so give me just a second, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], thank you for your patience on this. I'm trying to see if the waiver is gonna be communicated out to you guys because it has not been placed on a premium waiver at this time that I see. So that's the information I'm trying to get and I'm not not getting a clear answer, so I apologize for the hold.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I do know.
[AGENT][NEUTRAL] It would be the 90 days from the last day worked and so if
[AGENT][NEUTRAL] His last day worked was on [PII]. Uh, we're not quite to 90 days yet because March would be, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, the [PII] would be about 90 days, give or take a day.
[CUSTOMER][NEUTRAL] It would be next week.
[CUSTOMER][NEUTRAL] OK, so I just need to try back?
[AGENT][NEUTRAL] Yeah, because from my understanding that's communicated out as far as you know, when the premium would be on a waiver and because he did the return to work, it's 90 days of continuous and so because of the return, we just haven't quite hit the 90 days yet.
[CUSTOMER][NEUTRAL] Right. OK. So.
[CUSTOMER][NEUTRAL] So the 6 months, does it start when you receive the, um, does it start in January, I mean December or would it start in January?
[AGENT][NEUTRAL] It's the 90 days of continuous disability would start, I'm sorry.
[CUSTOMER][NEUTRAL] No, no, no, no, no, no, I'm not talking about that. I'm talking about the 6 months for the disability.
[CUSTOMER][NEUTRAL] I got the, I, I'm clear on the 90 days from now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I just wanted to know about the 6 months because I know the policy only lasts 6 180 days which is 6 months.
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] So I'm just trying to figure that out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me read on that and see what it says.
[AGENT][NEUTRAL] Maximum let's see.
[AGENT][NEUTRAL] So the 180 days would mean the period of time of which your effective date of coverage.
[AGENT][NEUTRAL] Of disability began.
[CUSTOMER][NEUTRAL] You said oh when the disability itself, when did the, the very last one begin?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me go back and double check on the date for that.
[AGENT][NEUTRAL] I wanna say it was August, but I'll double check the first claim here.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I thought they told me that when it starts all over when you go back to work.
[CUSTOMER][NEUTRAL] For at least 7 consecutive days, and he did.
[AGENT][NEUTRAL] Oh, for the 6 months?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] So if we're basing it off of the last time a payment was made and then you returned to work, then the first payment that I saw was for January.
[CUSTOMER][NEUTRAL] You don't see a payment in December?
[AGENT][NEUTRAL] I did not see one in December, no, ma'am.
[CUSTOMER][POSITIVE] OK. OK, so that answers my question. OK, thank you very much.
[AGENT][POSITIVE] OK. You're very welcome. Anything else I can help?
[CUSTOMER][NEUTRAL] No, that was it, thanks.
[AGENT][POSITIVE] Uh-huh, you're welcome. Have a good day.