AccountId: 011433970860
ContactId: a211b16c-4467-48ab-98f5-6bd1f41f5b75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1044050 ms
Total Talk Time (AGENT): 609636 ms
Total Talk Time (CUSTOMER): 328008 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/a211b16c-4467-48ab-98f5-6bd1f41f5b75_20250403T15:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. How are you? This is [PII].
[AGENT][NEUTRAL] Hi so how are you?
[CUSTOMER][NEUTRAL] No, I'm good, and you?
[AGENT][POSITIVE] I'm doing well thank you.
[CUSTOMER][NEUTRAL] Yeah, yeah. Um, well, I have a member of disability, uh, on the line, and, um, he is saying that we have the information that we're waiting for. Um, and I asked him for a, you know, I told him about a callback and he said no, he wants to speak to somebody right now. So, let me go ahead and give you the information. Uh, the policy number is 259-639-6.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it looks like based on the note from [PII], uh, we're needing the authorization claim form, but he says that he sent it on the second batch that it is there that he don't know why we're asking for it again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, let's take a look and see, and he said he sent it on the first claim or the second claim, or you're not sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like the second batch, the [PII], that's what he said he's supposed to be there.
[AGENT][NEUTRAL] OK, let me just, I'll just pull up each one and his name, the [PII].
[CUSTOMER][NEUTRAL] And golfing, uh-huh, yes, mhm, golfing.
[AGENT][NEUTRAL] OK, and that says callback number [PII]?
[CUSTOMER][POSITIVE] Yes, yes, and I did fully verify him OK.
[AGENT][POSITIVE] OK, and everything's verified. OK, great.
[CUSTOMER][POSITIVE] Yes. All right, you're ready for him?
[AGENT][POSITIVE] All right, you can go ahead and put him through, and I will assist them. Yeah.
[CUSTOMER][NEUTRAL] At
[CUSTOMER][POSITIVE] All right, thank you. Have a good day. Here you go.
[AGENT][NEUTRAL] You too bye.
[CUSTOMER][POSITIVE] Thank you. Thank you for holding and being patient for me, Mr. [PII]. I got Ms. [PII] on the line. She's gonna assist you from here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi Mr. [PII], my name's [PII]. I'm on the claims support team. Um, if you'll just bear with me for just a moment, I'm looking through the documents that you sent in. Um, Ms. So indicated that you said you sent in the form that we're asking for, and so I'm just reviewing that information, so bear with me for just a moment. I have to go in to each, uh, piece of, uh, each, each, uh, submission. OK, thank you.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And it looks like we had requested the attending physician form and there was an authorization form uh that we we needed to in order to reach out and request medical records and the adjusters indicating that she needs that form for authorization, so I did not see that form in the first submission, um, well, the first two that you sent in, so I'm, I'm researching it, uh, again.
[AGENT][NEUTRAL] Just to make sure.
[CUSTOMER][NEGATIVE] You know I'm about to lose my job.
[CUSTOMER][NEUTRAL] Behind all of this.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] It's, it's just disheartening right now.
[CUSTOMER][NEUTRAL] Bentley shut Popeye's door, please. Cause I asked you to.
[CUSTOMER][NEGATIVE] And, and this is very disheartening.
[CUSTOMER][NEUTRAL] Because I have been making every effort. I'm, I'm, I'm reading the bottom of this page. Your physician will complete a section entitled to be completed by and this is all, I'm only going by the instructions that were sent by the company I work for.
[AGENT][NEUTRAL] Uh huh
[CUSTOMER][NEGATIVE] And I, I turned in everything that was on this list, and now they're they're telling me you're missing one form and I and I and I double checked it when I sent it the last time.
[CUSTOMER][NEGATIVE] It's like every time I talk to somebody it's something different. And like I said it's it's really disheartening right now. Now, I sent in my attending physician, so do you consider a surgeon or the primary care doctor? Which, which one, cause it's not specific on here, on this.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEGATIVE] There, there, there should be something from a Doctor Cross and stating what is wrong with me. And that's why I purposely sent in 9 pages more, more than what was requested. So just everybody know what's going on.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So it looks like the the primary doctor that they're needing the information from is [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So they didn't need anything from the surgeon.
[AGENT][NEUTRAL] Right and actually what is what's happened here is it looks like um now you said that your your job actually provides you this information is that right? the form to fill out and everything?
[CUSTOMER][NEUTRAL] Well, they, they gave me a set of instructions that I followed.
[CUSTOMER][NEGATIVE] And from my understanding from APL some of the information that's on this form, this email that they sent me is not correct.
[CUSTOMER][NEUTRAL] Cause like I said, on the form it says your physician will complete the section to be completed by the attending physician.
[CUSTOMER][NEUTRAL] So you're considering my primary care doctor attending physician and not the surgeon that specifically documented what's wrong with me, if that's what I'm asking.
[AGENT][NEUTRAL] Right, yeah, and, and here's what's happened, um, and I'll try to explain this to you as best I can and unfortunately like I said, what we're needing is the authorization page that that's a page that you signed now normally it's included in the packet of.
[AGENT][NEUTRAL] Um, the disability, you know, that initial form, so there's a page that you fill out. There's a page your physician fills out, and then there's also a page that the employer would fill out. But in, and also what's what's included in that is that authorization and what the authorization page is allows us to do is reach out and get additional information if we need to make it.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] A specific determination regarding your claim that authorization allows us to do so but without that form we cannot reach out and get additional information for your claim because we don't have the proper authorization page that should have been um included in the packet and for some reason I do not see that here and that's what the adjuster is asking for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I'm listening.
[CUSTOMER][POSITIVE] I'm, I'm listening. No problem. I I apologize for interrupting.
[AGENT][NEUTRAL] No, that's fine and like I said, I'm just trying to explain it. I wanna help you as best I can, but like I said, it looks like we need that authorization form, and the reason being is that your policy is brand new. It was effective on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So when that um when when we receive a new claim and your policy is new we might have to reach out and just verify some information and that information most specifically would be that the injury or uh uh condition wasn't prior to your effective date of your policy so that's what the adjuster is trying to determine like I said that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That we have all all the information needed to make the correct determination, but what we're needing is that authorization form now um.
[CUSTOMER][NEUTRAL] What's the heading on that authorization form? What does it say?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Um, it would say just one moment, I'll pull that right up for you here now do you know, um, are, do you have access? it looks like you submitted your claims, um, did the broker or your uh or your administrator, uh, did they submit the claims on your behalf or did you send them to us?
[CUSTOMER][NEUTRAL] I had somebody send them to you.
[AGENT][NEUTRAL] OK, because I was gonna say we do have a portal and so what it's gonna say at the top of the form it's gonna say that it's like a sec it's it's labeled a section E but like I said it looks like the claim form you received is older claim form so it may be a little bit different, but the instructions on there do indicate that we have to have that authorization page returned and meaning that like I said that we have authorization to reach out on your behalf.
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] So on that first page of the form that was submitted um it's it's like I said it's a claim um it's for the disability claim but there are um several pages that are in within that claim form and one of them would be the authorization.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And it's an authorization to request request information including protected health information and it's all it is it needs a signature, a date of birth, and then uh I'm sorry you print your name, a signature, and your date of birth and then once we receive that, like I said, we can reach out and request that information but until we receive that we can't do anything with your claim until we are able to get the information needed.
[CUSTOMER][NEGATIVE] Is there any reason, um, because I've been going through this since [PII] that nobody reached out and told me that there was a section missing.
[AGENT][NEUTRAL] Well, it would have been, I'm not sure who you spoke to.
[CUSTOMER][NEUTRAL] Because like I said, I, I.
[CUSTOMER][NEUTRAL] I've talked to
[AGENT][NEUTRAL] And I do see, I
[CUSTOMER][NEUTRAL] I spoke to
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] I spoke to so many people. I have spoken to so many people and like I said right now it's really getting disheartening that, you know, I've been working on this since [PII] and this is the 2nd, well this is the 3rd time I have not been given the proper documentation from my job.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Because from my understanding from APL, the um direct deposit form they give me was not correct. Now you're telling me they didn't give me all of my other paperwork, that wasn't correct.
[AGENT][NEUTRAL] Well, unfortunately, um, Mr. [PII] and I can't speak to what you were told prior to and who you spoke with. I mean, I do see that there is communication here, um, but the, the last message received here we were asking for the authorization for the list of physicians, so you did provide us that information but we don't have the authorization form. So is it possible and, and there was um.
[AGENT][NEGATIVE] There was some instructions here about the HIPAA release that was received via email um and I'm looking at it now and it was indicated that we did need um that authorization release you sign and return but unfortunately I don't see that that page was included when the forms were sent back.
[AGENT][NEUTRAL] To us, so that's what's missing and that's all she needs is that that um release of information that and we call it a HIPAA form but it's a release of personal information and like I said it gives us the authorization to reach out on your behalf and obtain any information that's needed to determine your eligibility.
[AGENT][NEUTRAL] Um, is it possible I can send this over this form to you, um, via email and then have you, are you, do you have the uh.
[AGENT][NEUTRAL] Do you have the ability to sign it and return it to us?
[CUSTOMER][NEGATIVE] I would have to electronically sign it. I don't have a laptop in front of me cause right now I'm on FMLA and thanks to my job and the insurance company and everybody's sending, not sending me everything I need. I'm in jeopardy of losing my job, man.
[AGENT][POSITIVE] I'm sorry to hear that.
[CUSTOMER][NEGATIVE] I'm supposed to be back to work on June. I'm supposed to be back to work on [PII].
[CUSTOMER][NEGATIVE] And all of this has got me in jeopardy of losing my job.
[CUSTOMER][NEUTRAL] A job I've been on 19 years.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So, you know, uh, um, it's just disheartening right now. I'm, I'm, I'm, um.
[CUSTOMER][NEUTRAL] Is there any way I can electronically sign it?
[AGENT][NEUTRAL] Well, and that's what I was gonna ask you if I'm if I'm able to send it to you um via email now, um, here's what I, what I can have you do, um, you do not have an you said do you have a computer or you don't have a computer?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] No, ma'am, I don't. I'm on my phone right now. And what's going on with me? I, I'm having mobility issues. I have bone on bone arthritis.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's why I was trying to take care of everything on the [PII].
[CUSTOMER][NEGATIVE] And I was told, I, I've been told so many different things, it's not funny.
[AGENT][NEUTRAL] Well, and I apologize like I said I don't understand um it it does I do show like I said the communication they talked about the direct deposit form I see where you were sent that um and.
[AGENT][NEUTRAL] She's they emailed the form to you and then you were able to send it back to us so that's what I'm asking if I send this authorization form to you, are you able to sign it and send it back to us or we do have an online portal now generally it doesn't work well with a mobile device, but I mean we can try it because at this point that's all we need to get your claim.
[AGENT][NEUTRAL] Um, to get the information, you know, reach out for that information, but we do need that authorization page to be signed and sent back to us. So if I'm able to email that page to you or if you're able to go on to our portal, you can go ahead and sign it on the portal and then send it back through that portal. It's all electronic um.
[CUSTOMER][NEUTRAL] Um, what's the portal, um,
[AGENT][NEUTRAL] So the the portal is our like I said it's our online service uh online service account in from you know and like I said when you once you sign in I I don't show that you have an active portal so what you would have to do is go ahead and sign up sign up for that portal and uh you create a username and password and then it'll allow you access to the portal and then you can sign that form uh within the portal and what you do is you would have to.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] You know, kind of download the form, sign it, and then save it in a like a PDF file and then upload it back through the portal.
[AGENT][NEUTRAL] If you're able to do that.
[CUSTOMER][NEUTRAL] Ms. [PII], um,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Or can I just send you the form in the email?
[AGENT][POSITIVE] And you can try um you can try to get it back to us that way.
[CUSTOMER][NEUTRAL] You can send it to me.
[CUSTOMER][POSITIVE] You can send it to me email, yes ma'am.
[AGENT][NEUTRAL] OK, go ahead and verify your email address for me please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Now, um,
[AGENT][NEUTRAL] If you'll give me a few minutes I'll send this form over to you and if you'd like I'm gonna I'm gonna give you a call back, make sure you got the form and see if you're able to um like I said, basically you're gonna download it, sign it and go ahead and um upload it back to us or you know generally we don't use email because it's not secure means of transmitting information but it does look like that you have sent us previous information.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] In regards to that, um, your claim, so let me get let me send this over to you and I'll give you a call back shortly and just m[PII] sure you receive the form and see if you're able to uh save it for us and send it back to me and I can reach you at [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, give me a couple minutes. I'm gonna send this over to you, Mr. [PII], and then I'll call you back and I'll give you a few minutes, maybe say 15 minutes or so. Is that OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][POSITIVE] OK, just um, just hang tight for one moment I'm gonna send the form over to you and then hopefully we can get it uh situated for you, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Alright, I'll call you back shortly, Mr. [PII], thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.