AccountId: 011433970860
ContactId: cc3ad1f4-a8ef-427d-932c-5941d120e0d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1091790 ms
Total Talk Time (AGENT): 333018 ms
Total Talk Time (CUSTOMER): 232195 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/cc3ad1f4-a8ef-427d-932c-5941d120e0d6_20250210T18:44_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], it's [PII]. How are you today?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][POSITIVE] I'm doing good. Um, I have an insured on the line and I'm not able to locate something that he says was sent in.
[CUSTOMER][NEUTRAL] It's home policy number 2243426 for Mr. [PII].
[CUSTOMER][NEUTRAL] So I went over the latest claim process about the benefits being, you know, released after the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But he is saying that he's, and we show his return to work date according to notes as [PII], but he says he submitted information because he's gonna be having surgery and his doctor had put that there was no return to work date. I don't see any of that.
[AGENT][NEUTRAL] Mm, let me see from this, the mail that was, that's out here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see here.
[CUSTOMER][NEUTRAL] Because he's saying the 25, the 2 and actually we anyway he's saying that was the initial that was submitted but there has been other submitted that did not have a return to work date.
[CUSTOMER][NEUTRAL] I just don't say that.
[CUSTOMER][NEUTRAL] Because he's wanting to verify exactly, you know, what he needs to do and he said he had been told that, you know.
[CUSTOMER][NEUTRAL] He would have to do his portion monthly. I explained that that was correct and that's the only time the physician would need to.
[CUSTOMER][NEUTRAL] Um, submit as if his return to work status changed, isn't that correct?
[AGENT][NEUTRAL] Mhm. Yeah. So I'm trying to find the most uh current physician form that we have.
[CUSTOMER][NEUTRAL] And, OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, I do see on the most recent mail that we did receive on that claim that's out there that in the physician put anticipated return to work is um NA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He, yeah, that information we have, it, it does put in a.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Now what?
[AGENT][NEUTRAL] Normally, the, the disability adjuster will probably still verify by calling the physician's office, but let me verify that real quick. Hold on, let me send [PII] a message real quick.
[AGENT][NEUTRAL] Since it's, it's not a NA there.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] I mean since it's a NA there let's see here.
[AGENT][NEUTRAL] And has he mentioned if he's he hadn't returned to work, right?
[CUSTOMER][NEUTRAL] No, he's not mm mm. So, so yeah, so I mean.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I'm gonna check real quick with one of the disability examiners. Give me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hey, did she have a quick question?
[AGENT][NEUTRAL] We have an insured on the line calling just trying to inquire about um their disability. They needed any.
[AGENT][NEUTRAL] Additional information from us regarding um what we're gonna pay them up in 2. I was, I have pulled up the insured's physician statement and on the most recent physician's statement, it has um the physician put on the estimated return work as NA. In that instance, if the physician puts NA, do we normally just call the physician just to verify if they have returned work or the job, or is there more information we would need from the insured?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see on this
[AGENT][NEUTRAL] See if I can find the second page.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] See if that was page because they all separated here. Let me see what page number that one was.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that's page 6, page 7.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And uh let's see, OK, so page 8, it has.
[AGENT][NEUTRAL] No. Yeah, I'll share my screen.
[AGENT][NEUTRAL] I will
[AGENT][NEUTRAL] So this is the page 8, which is the policyholder's statement.
[AGENT][NEUTRAL] And I don't see it
[AGENT][NEUTRAL] Yeah, this is page 8.
[CUSTOMER][NEGATIVE] My own base is stuck to my own base is stuck. I can't, I mean.
[CUSTOMER][NEGATIVE] It has a gray circle in the middle of the screen it's not even moving.
[AGENT][NEUTRAL] See, this is the page 7.
[AGENT][NEUTRAL] I mean, page 6. No, this is page 6.
[CUSTOMER][NEGATIVE] Oh yeah, my home base is totally frozen.
[AGENT][NEUTRAL] Page 7 is, let me see which one this one is.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Page 56.
[AGENT][NEUTRAL] I think this one was
[AGENT][NEUTRAL] Mm, let me go back to this one.
[AGENT][NEUTRAL] Yeah, this is the 7th, but it doesn't have the next office visit date on this. This is page 7.
[CUSTOMER][NEUTRAL] I'm gonna put you on hold for just a second, [PII], OK, just to let him know that um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Speaking with you or if I'm transferring. I thought I was gonna transfer him but then just let me let him know that I have forgot about him, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Cause it looks like we paid him up until the [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] See, and I have, I see she has it pending.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Cause yeah, this is the, on the same mail, it's the same mail that they put return to work in a.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Physician form.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 021.
[AGENT][NEUTRAL] OK, up until that day.
[AGENT][NEUTRAL] So, but then this here, this pin mean that she's gonna release, release one the [PII] of this month?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So I probably have to have [PII] give him a call back? OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So she can advise him on what? OK.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I will let him know. Thanks for looking.
[AGENT][NEUTRAL] All right, bye.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes. Sorry about that.
[CUSTOMER][NEUTRAL] Hey, OK, that's OK. I didn't know what had happened because I was you I you and I was like, OK.
[AGENT][NEUTRAL] Yeah, I was
[AGENT][NEUTRAL] Yeah, you had, you had, you, oh you IM me, did you? I was having the shade. Oh, there you go. I have put you on cause then I was trying to hear her tell me and you have, I heard the music in my ear at the same time. Yeah, no.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well, I just wanna make sure you had done it right. When I put you on hold to tell him that I had, you know, haven't forgotten about him. When I came back, I heard music and I was like, oh, did you, did you put me on hold or
[AGENT][NEUTRAL] Yeah, what we
[AGENT][NEUTRAL] Yeah, I only put you on hold cause I was trying to hear her over the music.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] So, yeah, we're, we're gonna have to get his number to have the examiner give her, him a call back because it looks like they only paid him up until the return to work day and the only way that we can extend benefits possibly is if he has been still seeking treatment. So what we'll have to have the disability examiner give him a call.
[CUSTOMER][NEUTRAL] OK, can you just explain him that? Can.
[AGENT][NEUTRAL] To get his
[AGENT][NEUTRAL] Yeah, I'm just gonna let him know that we're gonna have a further reviewed and have someone give him a call back and I'll just get his name and, I mean, get his number and have one of the disability examiners give him a call back.
[CUSTOMER][NEUTRAL] OK, thank you so much for that since he, since he's been on hold and I told him I was gonna connect him with someone and you know I think it just be better if you were to tell him that y'all have looked at it, but you're gonna have to have the other examiner to contact him.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can send them to me.
[CUSTOMER][POSITIVE] Perfect, thank you so much and I don't hopefully nothing will happen with the call, but the phone number that's in the system for him, [PII] is the one that we would call back on if it dropped or whatever. All right, thank you so much.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Alright, bye bye.
[AGENT][NEUTRAL] Claims department, this is [PII].
[CUSTOMER][NEUTRAL] Hey, Ms. [PII], how are you doing today?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][POSITIVE] I'm great.
[CUSTOMER][NEUTRAL] Yeah, I was just trying to verify.
[AGENT][NEUTRAL] So you have some questions regarding your disability claim?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] I was just trying to verify that you guys did not need any more information uh information for me for this month.
[AGENT][NEUTRAL] So have you returned to work?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK. And are you still currently seeking treatment?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. And when's the, when is, when is the last time you had your last treatment?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Was it last week, I think. Yeah, last week I went in for a procedure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I submitted a new paperwork.
[AGENT][NEGATIVE] I see we do have new paperwork, but it does not list when you anticipated return to work day is and it doesn't even list any future treatment dates or anything like that on the information.
[CUSTOMER][NEUTRAL] They left open because
[CUSTOMER][NEUTRAL] They left it open cause I'm going in to speak with the surgeon on tomorrow on the surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you're just trying to determine if we need any other information from you?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I know they say y'all had to have all the information before the [PII].
[AGENT][NEUTRAL] Let me take a look here.
[AGENT][NEUTRAL] So from this information, it looks like your, the document that you completed looks like the most recent treatment you had based on what we have is [PII].
[CUSTOMER][NEUTRAL] That's why I went to the ER.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I'm still on for uh Doctor [PII].
[CUSTOMER][NEUTRAL] Doctor [PII] however you pronouncing that, Doctor [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm still under his care.
[CUSTOMER][NEUTRAL] As of now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I will have to have this further reviewed and reach back out to you regarding if we'll need any additional information and we can give you a call by the end of today. Can I verify your contact number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. We will give you a contact back by the end of today regarding it if there's any additional information needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, ma'am, that's what I want to verify.
[AGENT][POSITIVE] OK, well thanks for calling APO you have a good day.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Bye.