AccountId: 011433970860
ContactId: a8c54dd0-3ee9-4097-a2ac-00039550c528
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2314020 ms
Total Talk Time (AGENT): 891711 ms
Total Talk Time (CUSTOMER): 1077154 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/a8c54dd0-3ee9-4097-a2ac-00039550c528_20250212T19:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. So, um,
[CUSTOMER][NEGATIVE] Oh, I don't even know where to start. I just got a letter from you guys that I just don't understand what the letter is, um, you guys are my former carrier through my.
[CUSTOMER][NEUTRAL] Um, employer and now we have a new one as of [PII] um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So I'm just trying to, I have several questions, but, but, I mean, because I just don't even understand what this letter is.
[AGENT][NEUTRAL] OK, so you've received a letter from APO and you have some questions about.
[AGENT][NEUTRAL] Some things related to the coverage.
[CUSTOMER][NEUTRAL] Yeah, like what it even, yeah, it says your coverage is an insured welfare benefit plan under the Employment retirement income.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Security Act of [PII].
[AGENT][NEUTRAL] OK, so what I'll need to do first off is to locate your information first, and I'll have to verify some things with you for security and then yes ma'am I can help you. So uh who am I speaking with please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And Ms. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And does it reference a policy number on your letter?
[AGENT][NEUTRAL] Or do you have your policy number from when you had coverage with us?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It has a policy number on it.
[AGENT][NEUTRAL] OK, and what number is that? Mhm.
[CUSTOMER][NEGATIVE] It's 0.
[CUSTOMER][NEUTRAL] 022.
[CUSTOMER][NEUTRAL] 94124
[AGENT][NEUTRAL] OK, thank you. So give me a moment, Ms. [PII] to get your information pulled up please.
[AGENT][NEUTRAL] OK, so first off, Miss [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth for me.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII]. It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and lastly your email address, please.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so the um email, Miss [PII] that appears to be on file would have is your work email.
[CUSTOMER][NEUTRAL] Oh, so, um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying all of your information. Now, what is the date?
[AGENT][NEUTRAL] Of that letter that you received?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's a claim number too.
[AGENT][NEUTRAL] OK, if you want to go ahead and give me that, you can.
[CUSTOMER][NEUTRAL] 3553862
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so give me just one moment for to get that pulled up.
[AGENT][NEUTRAL] OK, so I show Miss [PII] that we processed this claim for you on [PII].
[AGENT][POSITIVE] And there was a benefit paid to you.
[AGENT][NEUTRAL] In the amount of $1,066.67 on that claim number.
[CUSTOMER][NEUTRAL] And that was the the final payment on the claim?
[AGENT][NEUTRAL] Yes, this shows that this was.
[CUSTOMER][NEUTRAL] Up to up to 2:10.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Now here's um have you guys heard anything from.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Either my new carrier or.
[CUSTOMER][NEUTRAL] My HR department about
[CUSTOMER][NEUTRAL] An extension, uh, because, or anything about a new diagnosis from my doctor.
[CUSTOMER][NEUTRAL] Because of chemotherapy and radiation.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, ma'am. As of now, that is the last piece of information that we have received.
[CUSTOMER][NEUTRAL] OK, so here's my, here's my question so my HR department is focusing on.
[AGENT][NEUTRAL] That was
[CUSTOMER][NEUTRAL] Asking, I guess.
[CUSTOMER][NEUTRAL] Trying to get the new organization.
[CUSTOMER][NEGATIVE] To open a new claim, but they won't because I can't, because I can't go back to work. So they're saying that I would need to contact you guys to get an extension, or I don't know, I, I have no idea how this works. Like, what happens if somebody's doing for critical illness for cancer, what happens if somebody's doing um
[CUSTOMER][NEUTRAL] Radiation and chemotherapy.
[CUSTOMER][NEGATIVE] And it's not, and it's, you know, like I'm not finished.
[AGENT][NEUTRAL] OK, so I show that your policy with APL will term as a [PII].
[AGENT][NEUTRAL] According to the information on file.
[CUSTOMER][NEUTRAL] So I, I can get paid out up until [PII]?
[AGENT][NEUTRAL] Yeah, let me, I'm trying to pull up some additional information just one moment.
[AGENT][NEUTRAL] OK, so on this policy, and I've pulled up your policy.
[AGENT][NEUTRAL] Um, and on the policy you have with APL, your maximum disability period.
[AGENT][NEUTRAL] It's up to 3 months.
[CUSTOMER][NEUTRAL] OK, so now.
[AGENT][NEUTRAL] It's injury or sickness, it is a 90 day.
[AGENT][NEUTRAL] Disability period on this policy.
[CUSTOMER][NEUTRAL] So what happens if since they have a new carrier.
[CUSTOMER][NEGATIVE] And I can't go back to work.
[CUSTOMER][NEUTRAL] I'm in this gray area, does that mean?
[CUSTOMER][NEUTRAL] I go on unemployment.
[AGENT][NEUTRAL] Now that would be a question, um, Ms. [PII] that you would have to discuss with your HR.
[AGENT][NEGATIVE] I wouldn't be answer that for you.
[CUSTOMER][NEUTRAL] Like I have, I've never been in this situation.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] All right, so.
[AGENT][NEUTRAL] No, because, no, that's OK because of this last payment showing that we paid through.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] 2:10.
[AGENT][NEUTRAL] Now, if there were.
[AGENT][NEUTRAL] Benefits still do, excuse me, due to you, is that, was that your initial return to work date or was that?
[AGENT][NEUTRAL] The max of your disability time period.
[AGENT][NEUTRAL] Let me see if I can determine when did you go out on leave?
[CUSTOMER][NEUTRAL] Uh, my operation was [PII].
[AGENT][NEUTRAL] In December? Was it [PII]?
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so this most recent claim that we processed on your explanation of benefits, one of the remarks states this payment complete your claim for this occurrence. Benefits have been paid to the date you were released to return to work.
[AGENT][NEUTRAL] Um, the other remark on this claim, which you're set up in the online service center portal, aren't you?
[AGENT][NEUTRAL] I think I noticed that where you could log in.
[AGENT][NEUTRAL] To see all your information.
[CUSTOMER][NEUTRAL] I, I have no idea.
[CUSTOMER][NEUTRAL] So now, here's a question. So if I'm under a different doctor with the chemotherapy and radiation, so that original claim was signed by my surgeon.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And now I've been moved over to an oncologist.
[CUSTOMER][NEUTRAL] Who in the, in the end of December started me on treatment.
[CUSTOMER][NEUTRAL] So what happens in a situation like that?
[AGENT][NEUTRAL] OK. So the doctor that currently has you out.
[AGENT][NEUTRAL] That is trading you that has you off of work would be who would complete.
[AGENT][NEUTRAL] The physician's portion and if your disability is going beyond what was initially anticipated, which is what this indicates that you were paid to the end.
[AGENT][NEUTRAL] Of or to your return to work date.
[AGENT][NEUTRAL] So they had initially, according to this anticipated that you would be returned to work by [PII]. Is that correct?
[CUSTOMER][NEUTRAL] That was, that was the surgeon.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So then we would have to receive.
[AGENT][NEUTRAL] Every month, just like you've been doing, like your claimant statement and the physician that still has you off of work.
[AGENT][NEUTRAL] In order for any additional benefits to be considered through the maximum disability period that this policy allows, which again that is the 90 days or 3 months.
[CUSTOMER][NEUTRAL] So what, what do I need to do?
[AGENT][NEUTRAL] OK, so you would have to have
[AGENT][NEUTRAL] That disability claim form that you initially completed.
[AGENT][NEUTRAL] That would need to be completed by the doctor who has you off of work beyond the [PII] date.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What I'm gonna do is
[CUSTOMER][NEUTRAL] So give it to the oncologist.
[AGENT][NEUTRAL] Yes, so what I'm gonna do, Miss [PII], is I'm gonna join one of our examiners um on the line with us who reviews, you know, this type of claim to verify that that is correct information because again.
[AGENT][NEUTRAL] There's going to be.
[AGENT][NEUTRAL] Approximately, it looks like about 10 days.
[AGENT][NEUTRAL] For this policy that you would have benefits remaining on if approved.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Since she went out November. So November to December, that's January to February.
[AGENT][NEUTRAL] So yes, but I want to confirm that it would be the oncologist that would need to complete that section of the claim form for us to review for any additional benefits beyond the [PII] date that we paid.
[CUSTOMER][NEUTRAL] Right, cause it's.
[CUSTOMER][NEUTRAL] Um, the initial diagnosis was like recovery from surgery. And this new diagnosis is essentially chemotherapy, radiation.
[AGENT][NEUTRAL] Correct. So, OK, so I understand you, ma'am, the question. I just wanna make sure of the information that I have given you to be.
[CUSTOMER][NEUTRAL] Treatment.
[AGENT][NEUTRAL] Oh no, correct, as far as how this would need to be handled.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So potentially,
[CUSTOMER][NEUTRAL] I can get paid up to 31, which is like 10 more days.
[CUSTOMER][NEUTRAL] You're saying for the policy.
[AGENT][NEUTRAL] Well, from 2:10 to roughly, right, because your client well approximately 10 more days like till the [PII] of the month.
[AGENT][NEUTRAL] To the [PII].
[AGENT][NEUTRAL] According to what I'm seeing.
[AGENT][NEUTRAL] Because your initial claim, you went out on your disability.
[AGENT][NEUTRAL] You had your elimination period from the [PII].
[AGENT][NEUTRAL] Of [PII] because you do have that.
[AGENT][NEUTRAL] 7 day
[AGENT][NEUTRAL] Sickness elimination period that was, had to be satisfied.
[AGENT][NEUTRAL] And your
[AGENT][NEUTRAL] Disability benefit initially paid.
[AGENT][NEUTRAL] For the two days in November the [PII] [PII] and then for your the entire month of December.
[AGENT][NEUTRAL] So with the examiner, we'll be able to determine exactly, you know,
[AGENT][NEUTRAL] How many more days you could potentially have benefits for if the claim were to be approved.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And it has to be signed by
[CUSTOMER][NEUTRAL] The current doctor.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Correct. We would have to have an, an additional, yes, any time the return to work date changes, then yes, ma'am, the physician has to complete their section of the form as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do you guys get the form to them?
[AGENT][NEUTRAL] Uh, you would just, you would provide that to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you still have a copy of the claim form you can print it directly uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The disability claim form is on our website, Ms. [PII].
[AGENT][NEUTRAL] Which is located our, our public website is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And when that page pulls up at the top you will see where it says claims and forms it's a link.
[AGENT][NEUTRAL] And if you click there and.
[CUSTOMER][NEUTRAL] So you said [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And you do not have a profile currently in the portal and I don't believe it's going to allow you to set one up since your policy is.
[AGENT][NEGATIVE] Showing is no longer active.
[AGENT][NEUTRAL] With APL, so that means you would just need to fax in your claims information because we can't accept it via email for security reasons.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But once you pull that website up that I gave you and click on the claims and forms link, if you scroll down the page, it starts listing out the different claim forms well actually there's a little box that says filter by product.
[AGENT][NEUTRAL] And it has a green drop down arrow in it.
[AGENT][NEUTRAL] And if you click on the little arrow, it's gonna give you a list of different forms and you'll see where it says disability.
[AGENT][NEUTRAL] And you would just click on the word disability and then you should see a blue button that says download form.
[AGENT][NEUTRAL] And that's the full claim form and then the first page of that claim form, Ms. [PII] has all of the instructions on it as well.
[AGENT][NEUTRAL] And our secure fax line is at the bottom.
[AGENT][NEUTRAL] Of the page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So, I fill out my portion and get it to the doctor and then they fax it back to you guys.
[AGENT][NEUTRAL] They can, yes, ma'am. It could all be sent together. Mhm. Now what we need to verify is because of it being a different physician that has you off. I'm not sure about this, your employer section.
[AGENT][NEUTRAL] So that's what I'm gonna address with the examiner when I join one of them on the line with us.
[CUSTOMER][NEUTRAL] Oh, so like on my first claim like the HR department filled out the first part and then sent it to me.
[AGENT][NEUTRAL] Right, so I.
[CUSTOMER][NEUTRAL] Like it was pre-filled.
[AGENT][NEUTRAL] Right, but I don't know if you're gonna need to submit that section again.
[AGENT][NEUTRAL] Since this is a different doctor.
[AGENT][NEGATIVE] Which that's, you're under their care now.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] That's one of the pieces of information that we need to verify.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Now, again, yeah.
[CUSTOMER][NEUTRAL] So you said we need to get somebody on the line.
[AGENT][POSITIVE] Yes ma'am I'm gonna join somebody in with us and again you will not have to re-verify any of your information. I will give them all of that and an overview of our conversation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with, Miss [PII] before I do that?
[CUSTOMER][NEUTRAL] Now what, what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] [PII], you've been very helpful. Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Oh, well, you're very welcome and I wish you all the best in your treatment, Miss [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am. So give me one moment and I'm going to join in one of our examiners, OK?
[CUSTOMER][NEUTRAL] OK, yep.
[AGENT][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] And again thank you for calling APL. I hope you have a very nice rest of your day today.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good how are you, [PII]?
[AGENT][NEUTRAL] Um, oh girl.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's been a day. I'm OK. I'm OK. So I have an insured on the line. Can I go ahead and give you the policy number?
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] 229-4124
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so her policy is showing as lapsed, but it's a 31 term date, OK? They changed carriers. All right, so she's been out on disability and the last claim that we processed for her paid her to her return to work date of [PII], OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The doctor that had her out was her surgeon.
[AGENT][NEUTRAL] But she is now under the care of the oncologist and she has not been she's not returned to work.
[CUSTOMER][NEUTRAL] OK, so they kept her out longer than the 2:10. She didn't actually return to work?
[AGENT][POSITIVE] Mm, that is correct. Now,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The questions are OK first off obviously the new carrier is not.
[AGENT][NEUTRAL] Taking will not let her file a claim, so I've told just explained to her she'll have to get to with our HR department about questions regarding you know how to handle beyond.
[AGENT][NEUTRAL] The window of time with APL, but her policy, according to what I see, [PII], shows that she has a max.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Disability a period of up to 3 months. It's 90 days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She went out on disability according to what I see in November, [PII] end [PII] November.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Does her disability, my my question for me, does the disability period begin with the seven day elimination date or the
[AGENT][NEUTRAL] Which would have been like, I think [PII] is when she went out.
[AGENT][NEUTRAL] From the [PII] is her elimination period and then we paid her.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So, is that included in the 90 days?
[CUSTOMER][NEUTRAL] Yes, that is included because that is when your disability began.
[AGENT][NEUTRAL] OK, so then if she went out on the [PII], that be to December to January until roughly say would be [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, roughly, mhm.
[AGENT][NEUTRAL] Maybe give her a day. So potentially she could have 10 more days of benefits payable to her. 1010 to 12, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so she's got.
[AGENT][NEUTRAL] She has the claim form. The question is, does the doctor, her oncologist need to be the one to complete the claim?
[CUSTOMER][NEUTRAL] Yes, so they will need to fill it out and essentially say that like why she is remaining out of work, um, filling out all those questions and everything and her employer will need to fill out their question confirming that she has not returned to work.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, in saying that, I was just going to, I have already basically, that's what I've told her. I just wanted you to confirm that the oncologist would be the one to complete the claim and to verify, right. And to verify that her, whether her employer would or would not need to complete.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, since that's who she's under the care of now, yeah.
[CUSTOMER][NEUTRAL] Yes, so since we, we paid to the return to work day, we would need that filled out to confirm she actually did not return.
[AGENT][NEUTRAL] Their section.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, so can I just join her in on the line with us? Because that's what I kind of, well, that is what I told her I was gonna do and I'm just gonna remain on the line so that I can hear you kind of validate what I've already told her. She's real nice, she's real sweet too and she's fully verified everything is correct in the system.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] OK, cool.
[AGENT][NEUTRAL] This is just kind of an odd one since, you know, for me it was was odd since the policy's ending.
[AGENT][NEGATIVE] And I just didn't wanna give her as usual. I don't ever want to give these people when they're going through all this stuff, anybody, but especially when they're dealing with stuff like this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, of course.
[AGENT][NEGATIVE] Incorrect information. That's my biggest fear.
[CUSTOMER][NEUTRAL] Yeah, well, at the very least we would pay through to the pay to date.
[AGENT][NEUTRAL] Right. And so that would roughly be about 10 more days if it's a 3-month period, right?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so, well, even if she had more than that, um, we would pay through to her pay to so her pay to date on the policy is 31, so we would at least pay through to 31 if she had more than 90 days still available.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, but she's been out since November. Well, that's what I mean, so, but for her, since she's been out on November.
[CUSTOMER][NEUTRAL] Yeah, that's what I'm saying though like if she had if it with her having 90 days if she had 6 months we would at least you know we're not going to, yeah, we're we're not gonna short them especially if we get information verifying she never actually went back to work.
[AGENT][NEUTRAL] Right. Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hey to 31.
[AGENT][POSITIVE] OK, alright, so let me join her and then um thank you so much for helping with this one. I appreciate it. OK, alright, so just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Of course, no problem at all.
[AGENT][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] Hi, this is [PII], and I also have one of our examiners, [PII] on the line. [PII], can you hear us?
[CUSTOMER][NEUTRAL] I can
[AGENT][NEUTRAL] OK, so Miss [PII], I gave [PII] an overview of our conversation, and she's going to just verify some of the things that I've already explained to you, so she knows that you have already had your information verified. So [PII], if you want to go ahead, um, that'll be fine.
[CUSTOMER][NEUTRAL] OK, um, Ms. [PII], I did want to confirm that we have, um, your disability beginning [PII], um, which is where your elimination period began, which is just a one week elimination period, um, which I'm sure you understand is just a period of time where you are disabled, you just don't get paid for that time frame.
[CUSTOMER][NEUTRAL] Um, your disability is, um, has a limit of 90 days for injury or sickness, and with this being a sickness, um, of course it qualified, um, so we will pay up to 90 days from the incurred date of disability. So what we would do is to um [PII] that you have not returned to work, um, so what we would need is we would need your portion.
[CUSTOMER][NEUTRAL] Of the claim form.
[CUSTOMER][NEUTRAL] Your provider that is now that you're now under the care of because I understand that you've been released from one provider but now you're under the care of a new provider so we would just need them to fill that out um verifying that essentially your disability is continuing because of this sickness and your employer would need to fill out their portion to confirm with us that you did not return to work.
[CUSTOMER][NEUTRAL] And then we would pay any remaining days of that 90 that are that are still available.
[CUSTOMER][NEUTRAL] So can you guys send that electronically to my
[CUSTOMER][NEUTRAL] To [PII] through my HR department, like you did before, and then she sent it to me, so they filled out their portion, then I filled out my portion, and then I took it to the doctor. Can we do it that way?
[CUSTOMER][NEUTRAL] Um, I'm sure if it was done before I will reach out to whomever handled um getting that information over before and just kind of confirm that um all of that was handled, you know, without needing anything specifically and if so absolutely we'll get that sent over.
[CUSTOMER][NEUTRAL] And then yeah, like my HR person [PII] is her name and I guess she filled it was like this whole top portion was filled out prefilled and then I filled out my portion I printed it out and then I took it to the to the doctor so if we can that seems to be the easiest way to do it. OK.
[CUSTOMER][NEUTRAL] Yeah, I that's if that's possible. Sure, like I said, let me, um, let me verify with whomever sent it previously that I don't need anything else specifically and as long as all I need to do is send the form.
[CUSTOMER][NEUTRAL] I will make sure that um that I get that sent over. I will verify the email and everything that it was previously sent to since that was successful and I will get that sent over if for whatever reason I do need something that we don't have um then I will make sure to give you a call back but if you didn't have to provide anything before I don't see that being an issue I just need to make sure on my end that I don't need to do anything extra. OK, so, um.
[CUSTOMER][NEUTRAL] Just a question, so if I, once I'm paid out my full amount, the last portion, does that make me like unemployed?
[CUSTOMER][NEUTRAL] Considered unemployed. So under the disability for us it would not mean that you're unemployed as far as we're concerned um it just means that you have exhausted your benefits for this particular disability um so as far as, as I understand it, [PII] states that you're now up under a different um carrier for your disability insurance.
[CUSTOMER][NEGATIVE] Now, the thing is, is they won't let me do anything until I go back to work with them.
[CUSTOMER][NEUTRAL] So until I am released to go back to work.
[CUSTOMER][NEGATIVE] Um, uh, basically, until I'm back to work, I can't even file a claim with them, they said. Is that because, like, I haven't paid into the policy through my check?
[CUSTOMER][NEUTRAL] Possibly, but what I would review with either HR because I don't know how your policy reads or anything like that um I can't speak to their policy language I would review with your HR benefits coordinator um if they have a takeover like information because if it's a takeover specifically for APO and this is just how we work so again I can't speak to them.
[CUSTOMER][NEUTRAL] If it's a takeover policy where essentially there is no lapse in policy it's just that it's moved to a different carrier, then a lot of things like preexisting or something like that are waived because you did not have a lapse in coverage and begin new coverage with us we just took over the coverage from a different company so um.
[CUSTOMER][NEUTRAL] I would discuss that with them because if they do have takeover verbiage in their policy where some of that information and stuff is waived then I would assume that any preexisting or anything like that would not apply but again I don't know how their language is so I would discuss that with my benefits coordinator on um how that policy is set up is it set up as a takeover or is it set up as if you.
[CUSTOMER][NEGATIVE] Lost coverage even temporarily even if it was just for a day.
[CUSTOMER][NEUTRAL] All right. I'm
[CUSTOMER][POSITIVE] I'm writing it down I definitely because I'm.
[CUSTOMER][NEUTRAL] All right, is new.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][POSITIVE] Set up as a takeover. Yes.
[CUSTOMER][NEUTRAL] I take over.
[CUSTOMER][NEUTRAL] Which means no lapse in coverage. Correct, it it there is essentially no lapse in coverage because all they did was bring you now your effective date will be with them obviously will not reflect the same thing as it does with us however because it is noted as a takeover then again per APL.
[CUSTOMER][NEUTRAL] language a lot of information such as is this a preexisting condition? have you been treated for it before all of that we will waive a lot of that in a lot of those I guess you could say exclusions um that would eliminate you from being able to receive payment because we took over for a different company so you've been paid here and you're continuing your disability but we've taken over your policy.
[CUSTOMER][NEUTRAL] So it's gonna depend on how that is within your policy with the new company. I don't know how they're set up. I don't know if they've done it as a takeover or as a brand new brand new policy with no takeover um and that may be why they're stating um that.
[CUSTOMER][NEUTRAL] You would have to return to work because it may not be listed as a takeover which means they may be considering this an existing or a preexisting disability for which they are not going to be liable to pay per your policy language so that's why you gotta figure out which one like how was it set up, how did that occur and your benefits coordinator should know that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm, I'm hoping it's a takeover because that that obviously would be more beneficial for you with, with your, um, oncologist not releasing you to return just yet um.
[CUSTOMER][NEGATIVE] But it's like, what does a person do? He said he already said I'm not going to be released back to work. He's like, I'm telling you right now you're not healthy enough to go back to work. He's like, so what you're gonna go back to work for two weeks to have a payment made and then we put a new diagnosis and all that technicality, you get sicker because you get exposed to something. That's exactly what my doctor said.
[CUSTOMER][NEGATIVE] Yeah, it's like it's not worth the risk basically.
[CUSTOMER][POSITIVE] But also to your point, you know, like it, it would be beneficial for you to continue to receive at least something.
[CUSTOMER][NEUTRAL] Right, and that's why I said like, I was reading online, if you run out of benefit money through short term disability.
[CUSTOMER][NEUTRAL] You know, it's technically that you're unemployed, so then like do you apply for unemployment until you go back to work because I have like an end date when all of my treatment stops, so.
[CUSTOMER][NEUTRAL] You know, but in the meantime that's not for like 8 weeks. Yeah, yeah, so you've still got, I mean at least 2 months there where you're not going to have any source of income, um, I would that's something else just from truthfully from personal experience, um, different situation but.
[CUSTOMER][NEUTRAL] Um, as far as why I was out, however, similar issue I would discuss that with, um, with my HR rep that is something else that I would discuss because they.
[CUSTOMER][NEUTRAL] In your state it's going to depend on what the unemployment looks like obviously you're not being paid, you're not receiving um compensation through time off or.
[CUSTOMER][NEUTRAL] You know, possibly disability or anything of that nature. however, are they still paying your premiums through for your health insurance? Are they still doing that? Because if they are, you may not be deemed unemployed, which would not qualify you possibly depending on your state for unemployment.
[CUSTOMER][POSITIVE] That is something that your HR rep will know as well um they should be able, in my opinion just with my limited knowledge of HR um they should be able to assist you in figuring out next steps um obviously no one wants to lose their job, um, I don't know how that would look for them if they're willing to keep you on for 8 weeks until you finish then you know, absolutely do that.
[CUSTOMER][POSITIVE] Um, but then the income situation and they, they should be able, I, I just firmly believe that they should be able to assist you with that. They should let you know what is going to deem you unemployed, um, but if they're still paying your premiums and everything, a lot, a lot of places to my.