AccountId: 011433970860
ContactId: a3985904-5e88-4e37-b160-566a2566f79e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 432600 ms
Total Talk Time (AGENT): 125426 ms
Total Talk Time (CUSTOMER): 320293 ms
Interruptions: 3
Overall Sentiment: AGENT=2.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/a3985904-5e88-4e37-b160-566a2566f79e_20250211T16:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII] in the care team. I've got a broker on the phone. Um, his name is [PII]. He is calling on policy number 230-1502 for Ms. [PII]. He's um handling this claim for her in the broker's office. He has some questions about the claim, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That I was unable to answer like is it paid in advance? is it paid in arrears?
[CUSTOMER][NEUTRAL] And I told him it should be paid in arrears because they have to get all that information together from the doctor and the employer so it wouldn't be paid in advance because they have to have all that claim information but I just wanna make sure I'm not telling him the wrong thing and I'm gonna go ahead and transfer him over to you so that you can answer that question for him.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Sure, no problem.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Mm bye-bye.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], um, I don't, um, I was calling about the status of a claim for an insured on the group that I'm the, I'm in the broker's office and we help do a lot of their administration.
[CUSTOMER][NEUTRAL] Um, and just wanting to, and I had some questions and I, I, I don't know if you can give me a different status update from the customer service person perhaps or.
[AGENT][NEUTRAL] OK, sure. And I'm speaking with [PII], right?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's right, or [PII]'s how I'm listed on the group contact info here, yeah.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Alright and also this is uh for [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, sure, I can take a look at that. I do have the policy up. I show that we have two claim submissions received on the [PII]. Um, they're in line to be processed, so they haven't been processed yet.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, yeah, OK, and, and then she told me it's normally 7 to 10 days and I guess I'm, I'm sure she told me, I'm sure that's accurate, so.
[AGENT][POSITIVE] Yeah, that's correct.
[CUSTOMER][NEUTRAL] Yeah, and, and, and she, she like a lot of short term disabilities, they're very eager.
[AGENT][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] So, um, yeah, um, and, and so, and then I was asking questions on how, you know, what to expect payment wise, you know, she said that that, uh, normally the payments are made around the [PII] and uh there are two files one the claims filed, and I think the other is the direct deposit authorization so hopefully that'll work, um.
[CUSTOMER][NEUTRAL] And, and, um, but anyway, so on the [PII], is it, is the disability paid like for the coming month or is it the previous month? Is it, is it always the previous month or how does that work?
[AGENT][NEUTRAL] Well, it depends on the information on the full claim profile. So that's the insured portion of the claim form, the doctor as well as the employer. Um, once that information is received and processed, the claim, the benefits will be paid for the current month and or any months prior to if it's, um, if the disability started, um.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] In the previous month, so it'll pay up to the current month and then.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Each month, the insured would submit the insurer's portion of the claim form to uh submit for that month, if that makes sense. Yeah.
[CUSTOMER][NEUTRAL] Yeah, so, let's use real base to make sure I'm understanding correctly the, the when you say quote current month, OK, well, OK, so in this case, the, the, if it's approved, right, you know, I think, I think this will be approved. It might require more paperwork, but it's pretty obvious that she's, she's had a stroke of some kind.
[CUSTOMER][NEUTRAL] Um, and, and, and you know, was in a hospital for a week and then is now in a rehab facility. Um, so, so, um, it, it was the, the, the disability occurred on the [PII], so I think that means either the [PII] or the [PII] when, you know, after her seven-day waiting period. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then, and so does that, and so does that mean if let's just say it got approved uh tomorrow or Thursday, would that mean the payment would be for since [PII] and then it would go through what is the current month mean? Does it mean the month of February in that case for your example?
[AGENT][NEUTRAL] That is correct, yes, at the time the claim is processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that means she would get, OK, so in roughly the [PII] of each month you get paid for that calendar month.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Um, yeah, and, and so in her case, um, well, even if it, it, uh, so she could probably expect a full month's payment plus, you know, another 10 days, um, but, uh.
[CUSTOMER][NEUTRAL] If it once it's approved, does that sound, does that sound accurate?
[AGENT][NEUTRAL] Uh, yeah, depending on the information provided, it's hard to say, uh, dates can be, uh, subjective. So, yeah, ideally, that would be the case.
[CUSTOMER][NEGATIVE] Oh yeah, [PII]o.
[CUSTOMER][NEUTRAL] Yeah, no, the information provided. Yeah, if the information provided doesn't indicate that the disability will continue past, you know, any given day, you know, like today for that matter, then it might not be approved for the full payment. Is that, is that for the full month? Yeah, yeah, yeah, I understand that.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, and then, um, and, and so, OK, and so basically each month she probably has roughly a couple of weeks to get the form submitted that says yes my disability is continuing and we'll continue through the end of the month and and um uh yeah OK and and and and uh I think I already understood this but you know as information created it will be added to the website correct? is that um.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Yes, once the claim is processed and there's been a claim decision you'll be able to view the status and the claim decision online.
[CUSTOMER][NEUTRAL] OK, as well as probably it it will probably tell me what payment has been processed, etc. is that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, that's great. Uh, she, she, I don't get, I, I asked her. I don't normally have to get involved with this. You guys do such a great job and uh and, and I, she, uh, uh, and, and, you know, next thing I know she's calling 5 people at the employer and they're all like she needs her.
[CUSTOMER][NEUTRAL] I'm like, well, usually I don't have to get involved. Well, and, and then I asked her and she goes, well, I'm in a hospital and I can't get my mail and I'm like, you don't have anybody that a family member or something that helps you and I, I, I guess the answer is not really. She's just really fiercely independent, I guess so.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] definitely understand.
[CUSTOMER][POSITIVE] So this, this, yeah, no, I, I appreciate you guys and I appreciate you helping me understand all that, and now if I have this in the future I'll, I'll know what to expect so.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Absolutely, and we're here to help.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Yeah, I know you are so y'all do a great job appreciate it. OK, alrighty, that's that that thank you you've been most helpful I appreciate answering all my questions.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] No problem, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, all set, thank you.
[AGENT][POSITIVE] Alright thank you thanks for calling ATO have a great day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thanks bye.