AccountId: 011433970860
ContactId: a1abe5b7-1919-4f50-8428-6e9f4df74d59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1033300 ms
Total Talk Time (AGENT): 439797 ms
Total Talk Time (CUSTOMER): 343062 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/a1abe5b7-1919-4f50-8428-6e9f4df74d59_20250528T20:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Are you in customer care?
[AGENT][NEUTRAL] Um, yes, ma'am. Can I help you with something?
[CUSTOMER][NEUTRAL] This is [PII] and claims. I was just wondering who, who I got.
[AGENT][NEUTRAL] Oh yeah, I'm, I'm part of the care team.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. I have a man on the phone that I need to get to this somebody disability.
[CUSTOMER][NEGATIVE] He said he called yesterday and nobody has called him back.
[AGENT][NEUTRAL] And he needed information on his disability?
[CUSTOMER][NEUTRAL] Yeah, I gave him all the information and the denial, but he wanted to speak to somebody who actually processes the disability claims.
[AGENT][NEUTRAL] Well, I would have thought that that was claims. Let me look it up real quick.
[AGENT][NEUTRAL] Uh, what's his policy number?
[CUSTOMER][MIXED] Yeah, it is fine, but I don't do disability.
[CUSTOMER][NEUTRAL] So do I need to call?
[AGENT][NEUTRAL] Is it a big?
[CUSTOMER][NEUTRAL] Somebody in um
[CUSTOMER][NEUTRAL] The other key
[AGENT][NEUTRAL] Uh, let me, let me see what's his policy number real quick.
[CUSTOMER][NEGATIVE] It is 02597994 and he didn't want to leave a message or get a call back because he already did that and nobody's called him back.
[AGENT][NEUTRAL] Oh look at that.
[AGENT][NEUTRAL] Oh my gosh. OK. Yeah, he's been calling every day for a couple of weeks, um, because we've been waiting for his doctor. So he actually doesn't go through us because it's disability, um, and since they're through BC, disability claims go to
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh shoot, now it goes, goes through us, but we have to, we were waiting on something.
[CUSTOMER][NEUTRAL] Right, it's already been denied though for pre-existing and he said it was not preexisting. He wanted to talk to somebody.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, well, if nothing else I can always escalate him to a manager we'll we'll see, um, did you?
[CUSTOMER][NEUTRAL] But I, I don't know how else to transfer it to somebody in disability because when we call y'all, it goes straight back to you all.
[AGENT][NEUTRAL] Yeah, um, give me just a moment let me see if my manager wants to take this because he called twice this week and I think he called a couple times last week because we've all had them, um, so let me see if we just need to have a manager take care of him real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, I guess I need to go into.
[AGENT][NEUTRAL] I'm new so I'm trying to find all these little teams chats and where everything's at and it's takes me a minute to find them, but.
[CUSTOMER][NEGATIVE] I didn't know how to get him to somebody in this ability.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I know we're supposed to take a number and have somebody call him back, but he does not want that.
[AGENT][NEUTRAL] OK, give me just a second, um.
[AGENT][NEUTRAL] And did you verify him?
[CUSTOMER][NEUTRAL] I did, yes, I got all, all the information you need his callback number?
[AGENT][NEUTRAL] Um, yeah, go ahead and give me his callback number.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, and um, I, I apologize, you said you verified him and everything already?
[CUSTOMER][NEUTRAL] Yeah, I did.
[AGENT][POSITIVE] OK, thank you so much. You can go ahead and transfer him over if you'd like.
[CUSTOMER][NEUTRAL] His address and all of that. I'll verify all of that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] Hi [PII] are you there?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right. I heard that you had some questions about your disability being denied.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, how can I help you?
[CUSTOMER][NEUTRAL] Yeah, I didn't have a bone infection before. I only got the bone infection.
[CUSTOMER][NEUTRAL] When my toes swelled up, it was not preexisting.
[CUSTOMER][NEUTRAL] So I don't understand how.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You guys come to that conclusion.
[AGENT][NEUTRAL] OK, let me see real quick what we can do.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] What's going on with your disability?
[CUSTOMER][NEGATIVE] I was supposed to get a call back today. Was they not gonna call me?
[AGENT][NEUTRAL] Um, I don't deal with callbacks. That would have been someone else. We've been, uh, pretty busy, but we should have called you back today before the end of the day. Um, let me see what's going on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing that you've been.
[AGENT][NEUTRAL] Applying for this disability since around March.
[CUSTOMER][NEUTRAL] [PII]. And it was emergency surgery. I had no idea I was even getting my toe amputated until [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 17
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or I didn't even have it amputated then, so I didn't even know that I had a bone infection until the [PII] and then I believe it was the [PII], they cut my toe off and then 22 weeks later they cut another toe off.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because of a blood infection.
[CUSTOMER][NEUTRAL] Due to diabetes. I did have diabetes, but it didn't.
[CUSTOMER][POSITIVE] There was no preexisting bone infection.
[AGENT][NEUTRAL] OK, they could have.
[CUSTOMER][NEGATIVE] Had no clue there was a bone infection.
[AGENT][NEUTRAL] Yeah, they could have thought that the infection was due to diabetes. Um, and I don't know that for sure. I'm just thinking based off of what you, what you've told me, um, let me see.
[CUSTOMER][NEUTRAL] Can I ask you a question?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] How can you, how can your company ethically sell?
[CUSTOMER][NEUTRAL] Temporary disability insurance.
[CUSTOMER][NEUTRAL] When I had the diabetes and I would've wrote down I had diabetes if you had any kind of a screening.
[CUSTOMER][NEGATIVE] I'm gonna have diabetes the rest of my life.
[CUSTOMER][NEUTRAL] So how could you possibly take premiums?
[CUSTOMER][NEUTRAL] I mean, I've had diabetes for 15 years and never got a toe cut off.
[AGENT][NEUTRAL] Um, because this does.
[CUSTOMER][NEGATIVE] That's silly to say that that was preexisting whenever.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] How could you take a, how could you take a premium?
[CUSTOMER][NEUTRAL] Without a, without a, uh.
[CUSTOMER][NEUTRAL] Some sort of a screening.
[CUSTOMER][NEUTRAL] And ethically say that I had a preexisting condition whenever I would have disclosed I had.
[CUSTOMER][NEUTRAL] Diabetes.
[CUSTOMER][NEGATIVE] I had no clue I was getting my toe cut off and it was emergency surgery both times.
[CUSTOMER][NEGATIVE] It just doesn't seem like that is a very Christian or ethical thing to do.
[AGENT][NEUTRAL] I think your best route for this, um, because if it's not due to that preexisting condition,
[AGENT][NEUTRAL] Um, I would file an appeal since it has been passed. Um, it's past due for one, so you typically have to wait 180 days until your denial. Um, it looks like we've passed that. Um, so I would file an appeal for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there any way you could, is there any way that you could send me the link? Because I have to have help. I'm, I'm not real smart with my phone and I have to have someone help me with it so.
[CUSTOMER][NEUTRAL] If I try to get into my stuff right now I'll probably shut something off instead of, you know what I'm saying? I'm not real high tech, so I'll have to have my wife help me if you would send me that link, I would be very appreciative.
[CUSTOMER][NEUTRAL] Because I mean, I'm sure my doctor told
[CUSTOMER][NEUTRAL] Your medical doctor that it wasn't a preexisting condition because he told me that.
[AGENT][NEUTRAL] Yeah, let me see, um, each policy has an appeals, um, process. Let me see what it is real quick for your policy, and then I'll be able to help you out with that.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, I know it's not your fault this is just.
[CUSTOMER][NEGATIVE] Really frustrating.
[AGENT][NEUTRAL] Oh, I can only imagine.
[CUSTOMER][NEUTRAL] And I didn't look into whenever I bought the money or bought the insurance with the.
[CUSTOMER][NEGATIVE] You're this not being a major medical bill, I ended up paying 7 weeks of $157 a week and you guys, your company literally paid like less than $2000 on almost $100,000 worth of surgery.
[CUSTOMER][NEUTRAL] So I mean
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] It seems like I got [PII] all the way around on this.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] What we need to do to file an appeal, um.
[AGENT][NEUTRAL] So you'll want to file an appeal or you can even have your doctor file the appeal for you. It'll be similar to a claim. Um, let me see if you need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you need, do I need to give him papers? I'm sure could you email me those?
[AGENT][NEUTRAL] Um, he will need to give you, um, paperwork and let me see exactly what he's needing.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like you'll need to get the doctor to um explain that it wasn't from your diabetes, the pre-existing condition, and it was due to an infection unrelated. Um, but let me see if there's a form or what we need to do specifically for your claim to get all of that done. Um, I don't think there's a specific
[AGENT][NEUTRAL] Um, site that I send you to except for our claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You will want to whenever you do send all this in or have your doctor send this in, um, have them send in any of the denial reasons.
[AGENT][NEGATIVE] Um, to show that it was denied due to.
[AGENT][NEUTRAL] You'll probably want to send it in for all of them since I'm showing that all of these have been denied for the same reason.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What we will need from you, from you.
[AGENT][NEUTRAL] Um, is a formal written letter with the policy number and a written statement of why you are appealing the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you can just uh if you want to you can type that out you can uh writing it would be a little bit harder just because um typing it is a little bit easier and then you can sign it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's from you and then you will need to send in supporting documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that will be um stuff that your doctor can give you, such as um anything that shows that it wasn't from your preexisting condition. It was due to an infection that was completely unrelated. So you'll want your doctor's statement and anything he might have that can help show that.
[AGENT][NEUTRAL] Um, and whether or not that was in your, your claims, I, I can't tell, um, because I'm not in the claims department, but I would go ahead and even if you sent it already, any document that shows that it wasn't due to diabetes, it was due to an infection that you had while this policy was active and it was not pre-existing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and from there it will go, um, once you send that in and I can give you the fax number or the um mailing number for that. It's going to be similar to the one for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] I'm driving right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you could text it to me, can you text it to me?
[AGENT][NEUTRAL] Um, we don't, we don't text it. Um, I can send you.
[CUSTOMER][NEUTRAL] Or email it to me but.
[AGENT][NEUTRAL] The fax number and PO box and everything that you might need. Your doctor may have it too. Um, who, who filled out the claims that were all denied? Was that you or was that your doctor?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just filled out my part. Doctor [PII] filled it out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you, they also got it from my primary doctor that.
[CUSTOMER][NEUTRAL] No I didn't have a bone infection. I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know who it's been 3 months and denying me and pushing it off.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I was gonna say it's gonna be the same number as if you were to file the claim um I will go ahead and send out that information to you as well. Uh, do we have an email on file? Is the email that we have on file still OK to send?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, yeah, if you'd send that to me I'll get on that and I think I have a doctor's appointment next week.
[CUSTOMER][POSITIVE] Because I'm still healing up from it, so I will see him next week and we'll get it sent off.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what I
[CUSTOMER][NEUTRAL] He's so busy that I probably won't be able to see him before, you know, because he does like 80 patients a day.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] What I will do, uh do you have an online portal account with us?
[CUSTOMER][NEGATIVE] No, I'm not that good. I've, I've tried to do it, but.
[AGENT][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] So what I'll do is um when I send you that email.
[AGENT][NEUTRAL] I will, um, basically copy and paste all of the notice of the right to appeal from your policy um and put it in there. I won't change any of the information. It'll be just what your policy shows um it's in your policy document, all of your notice, um, to appeal, and I'll put that in there as well. Uh, so what it will do is after you get all of those documents in and you turn all of that into us, it will go to our appeals board.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it will take um
[AGENT][NEUTRAL] At least 45 days to look it over.
[AGENT][NEUTRAL] Or no later than 45 days. I'm sorry, I read that wrong.
[AGENT][NEUTRAL] Uh, so it looks like it will take them up to 45 days to review that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well if you could send me that, I appreciate all your help.
[AGENT][NEUTRAL] So yeah, I want to
[AGENT][NEGATIVE] Yeah, anytime. I know that's gotta be incredibly frustrating. Um, yeah, just get, get a note from your doctor, get any evidence or anything that you think will show or your doctor might be able to help you show that it was due to the infection um unrelated to diabetes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And even if your doctor has to write a note, I would still send that in as well. Um, anything to help, OK?
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][POSITIVE] OK, thank, thank you very much.
[AGENT][POSITIVE] Right, thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Right, bye.