AccountId: 011433970860
ContactId: cd60eebf-c87d-4d9f-a45b-b4888ba2d147
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1332239 ms
Total Talk Time (AGENT): 590823 ms
Total Talk Time (CUSTOMER): 604496 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/cd60eebf-c87d-4d9f-a45b-b4888ba2d147_20250109T20:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How you doing?
[AGENT][POSITIVE] Doing well [PII] thank you how are you?
[CUSTOMER][NEGATIVE] I'm OK. Um, I have a, I don't know, frustrated customer on the line. Um, she faxed in two faxes, one on [PII], 1 on the [PII]. We don't have the one from the [PII], but I do see the one from the [PII], um, but she has a confirmation, so she's bent on that. Misty tried to help, but she didn't see it either. Um, she's now asking to speak to the examiner who processes her claim, but [PII] is away. So is there any other solution?
[CUSTOMER][NEUTRAL] To get her to speak to somebody.
[AGENT][NEUTRAL] Um, go ahead and give me the policy number.
[CUSTOMER][NEUTRAL] OK. It's 620.
[CUSTOMER][NEUTRAL] 424.
[AGENT][NEGATIVE] And so she's just upset that we don't have the facts. I mean, if we don't have it, we don't have that, but.
[CUSTOMER][NEGATIVE] I mean, I think she's just upset period at this point cause I, I'm just checking facts and and she's mad. So I think she's just upset um and she had that confirmation there that it was sent successfully, but that doesn't mean we received it successfully. But, you know, um.
[AGENT][NEUTRAL] So we ask for information?
[CUSTOMER][NEUTRAL] Yeah, um, so she's gonna be, I guess it sounds like the, however long she was supposed to be out is being extended. She's not returning to work and that's what was sent on the [PII], the doctor's note with everything.
[CUSTOMER][NEUTRAL] But we don't see it.
[AGENT][NEUTRAL] OK, let me, and what was that I'm, I'm pulling it up now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What was sent in.
[AGENT][NEUTRAL] I mean, I'm not really sure what I can help her with. I mean, honestly, I don't, I'm not trying to be mean. I just, I don't know.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] I'm gonna look at what was sent in on the [PII].
[AGENT][NEUTRAL] So we just needing it looks like the doctor's form is that what it is?
[CUSTOMER][NEUTRAL] Mhm. And she said it was the um the doctor has filled out and has a note to it too, um, as to why she's not returning to work.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] If anything, you know what, let me see.
[AGENT][NEUTRAL] I was gonna look and I'm looking to see if it's something that maybe wasn't indexed.
[CUSTOMER][NEUTRAL] That's what [PII] said.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But I don't think I, she didn't either. I don't think she saw it, but by the time I got back on the phone, the lady had or the, the insured had asked to speak to her examiner. So looks like [PII]'s on lunch though. You think I should just have her call her back? Oh [PII], I don't know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, well.
[AGENT][NEUTRAL] I mean, the best case scenario I guess is that we can try to contact the doctor's office and ask him to fax it again. If we don't have it, we don't have it. Um, I'm gonna.
[AGENT][NEUTRAL] Um, it suggests that to her. I'll get the phone number from her doctor's office, and I mean, I, that's the only thing I can think of to try to comfort her or whatever and calm her down, you know, um, that would probably be the best case scenario is that we extend that offer to contact them and see if they'll uh resend it to us since we don't have it. Um, I think I have the doctor's information, but I'll just, um, I'll speak to her and, and let her know that that's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, our only solution at this point, so if you wanna go ahead and she's been verified and all that, correct?
[CUSTOMER][POSITIVE] Yes, she's totally verified.
[AGENT][NEUTRAL] And that's her number there, the [PII] number or [PII]. OK, OK, you can go ahead and transfer her and I'll try to, like I said, intervene with the doctor and see if we can get the information resent, OK.
[CUSTOMER][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] Get it.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. Hold on one moment, OK?
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] Hello [PII]?
[CUSTOMER][POSITIVE] Yes ma'am. Thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Hi, Miss [PII]. My name is [PII]. I'm doing well.
[CUSTOMER][NEUTRAL] Hi, how are you? How are you doing? I was talking.
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEGATIVE] Uh, not fine because I, I faxed in some information to you on Tuesday and Wednesday, and the lady was trying to say that I didn't fax it in, and I have confirmation. I faxed it to the [PII], and they say y'all received it at [PII]. I faxed in a letter from the doctor stating I was not going back to work and she advised me to apply for a social security disability.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And I faxed in the information to show that I'm still going to therapy because the man was like, he don't know when I'm gonna be well. My back is messed up and I have two torn rotator cuffs and 3 spots on both of my shoulder, frozen shoulder. I got, when I fell, I hurt myself.
[AGENT][POSITIVE] I'm sorry to hear that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, you all should have everything cause I faxed in everything.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So, um, I'm in the process of looking through our faxes, possibly looking to see if it's not been um pushed out to your file yet. So I'm gonna look through there.
[CUSTOMER][NEUTRAL] Yeah, it should well I put the, uh, I put the uh policy number on the um on there on um uh Tuesday when I faxed the letter from the doctor, um.
[CUSTOMER][NEUTRAL] With from, it's from, it's from shy [PII]'s in uh imagine better health and it's it's a it's on a letterhead from my doctor, you know, stating that I will not be back to work and to apply for Social Security disability because it's not much improvement and I won't be returning to work and I sent you that letter and I sent you the letters from my, my um the notes from the therapist, you know, showing I still go to therapy and I'm gonna be there.
[AGENT][NEUTRAL] OK. All right, so this is what I'm gonna do since I don't see the fax, what I'm gonna do is go ahead and reach out to the doctor's office and ask them if they can, is that where it came from was the doctor's office or you faxed it to us?
[CUSTOMER][POSITIVE] No, no, I faxed it to you all. I faxed it to you all. And if I can, if I can, I can take a picture and upload it to you all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you have
[CUSTOMER][NEUTRAL] But I
[AGENT][NEUTRAL] Yeah, do you have, um, let me just check some information here.
[AGENT][NEUTRAL] So I see the um progress notes from the therapy um and I think that was already verified for you um.
[AGENT][NEUTRAL] Uh, that we did receive that part and that was faxed in on the [PII]. So this was a separate fax that was sent and it was the doctor's information on his letterhead, is that right? Do you know about how many pages?
[CUSTOMER][NEUTRAL] On her
[CUSTOMER][NEUTRAL] Uh, it was just one on her letterhead and I faxed it. It was from FedEx.
[CUSTOMER][NEUTRAL] And I faxed it to the [PII] and it was um accepted at [PII] I faxed it from FedEx. I got my policy number on the top of it 620424.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And if I need to send it to you uh by email or whatever I can.
[AGENT][NEUTRAL] Yeah, cause like I
[CUSTOMER][NEUTRAL] Cause I can, I can take.
[AGENT][NEUTRAL] Well, what I was gonna suggest is I could contact the doctor's office and have them fax it to us again. But if you actually fax it, then it probably, I mean, I don't want them to have, I don't, I don't wanna bother them if we don't need to, um, cause I know that they can be busy and sometimes they can put a charge on for that kind of thing too, and we don't want that. We don't want you to get charged for that, uh, especially if you've already.
[CUSTOMER][NEUTRAL] Yeah, so what?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What I would do if if I can I have it and I can send it to you by email right now I can attach it as attachment and uh take a picture of it and send it to you and you can print it out.
[AGENT][NEUTRAL] OK, so, um, I guess that would probably be the best scenario um are you able to use our portal online or do you have just email capability?
[CUSTOMER][NEUTRAL] Um, I, I, um, signed in online and, um, let me see.
[CUSTOMER][NEUTRAL] I'm signed in online right now, but hold on just for a second, OK, it's inactive.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm, I'm in online, but the only thing, OK, it says my claim upload files.
[CUSTOMER][NEUTRAL] OK, let me see if I can upload it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What it says enter claim details. So it says enter my claim details. What is it? I, I've never did anything, OK.
[CUSTOMER][NEUTRAL] [PII] page.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We just need that page you can just, you don't need to upload any of that just that document that you're describing is what we is it sounds like that's all we would need is that page.
[AGENT][NEUTRAL] So you don't have
[CUSTOMER][NEUTRAL] Well ma'am, um, let me let me send it to you by email because it's not, it's not doing it.
[CUSTOMER][NEUTRAL] Uh, let me send it to you by email. Is it if it's OK if I send it to you by email, I can email it to you right now.
[CUSTOMER][NEUTRAL] Cause I paid for that to be, you know, saying and saying it. I don't know what happened to what y'all did with it, but.
[CUSTOMER][NEUTRAL] Um, do you have an email address I can send it to?
[AGENT][NEUTRAL] Well yeah I can give you our care team email address. Generally we don't accept email claims information and the reason why that is that is to protect you because if there's, you know, private health information on there when we send emails it's not secure so um that's why we recommend either using that secure fax, mailing it to us or uploading it through the portal.
[AGENT][NEUTRAL] Um, however, like I said, I, I understand that you faxed it. I'm not sure why you did receive that confirmation. Now what I can do is, um, like I said, I can go ahead and give you that email address, but just to let you know, like I said, it, it, it's not recommended since it's not secured, um.
[AGENT][NEGATIVE] But I can give that to you as a last resort if you'd prefer to send it to us that way. And you said it was just one page, right?
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEGATIVE] Yes ma'am. It's got the policy number on the on the top of it. That's what I don't like. You, I said, I, I went and paid for that and then you all have lost it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK, so what is the email cause I can't get out. It's it's snowing and stuff here. What is the email?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's, it's the word [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it's uh [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], do, do I need to spell out [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just uh verify some information.
[CUSTOMER][NEUTRAL] Do I need to put my claim number on there?
[AGENT][NEUTRAL] No, if you have your policy number on there that should be sufficient.
[CUSTOMER][NEUTRAL] 620424
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And what do I need to say?
[AGENT][NEUTRAL] You'll just, um, like I said it's the [PII] just put in your subject line um uh you can put.
[AGENT][NEUTRAL] Either correspondence or claim is fine and then just attach that uh uh attach that document in the email.
[AGENT][NEUTRAL] And it what's gonna happen is it's gonna go to our care team. They'll respond to you and let you know it's been received, um.
[CUSTOMER][NEUTRAL] OK, you said
[CUSTOMER][NEUTRAL] It says care team at [PII] and then I got my claim uh you know my policy number is 620424 and then I'm I put uh I put uh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Correspondence on it and and I and you have it you can just print it out because you can see it very well and I, and I'm I'm sending it now and I just sent it but I don't understand how is it that you all can lose my information when I faxed the first, when I initially did the claim and everything. I always faxed it from FedEx and you all lost this this paper because I have confirmation. I can't even shoot you an email to show you that it was confirmed.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh huh
[AGENT][NEUTRAL] Well, like I said, unfortunately I can't speak for what happens with it any kind of correspondence. I mean, I'm in the claims department so what happens is when we receive that mail just like the email you sent to us.
[AGENT][NEUTRAL] It will go to our uh male team and then basically it's it's kind of like a male team and what they do is they um they have to put some information on as as opposed you know something similar to when it comes through our um online portal.
[AGENT][NEUTRAL] What they do is they assign some series of numbers to it and they'll go ahead and attach it to your file and then it gets pushed out to your file so what happens from the time it gets transmitted to it comes to our mail department I really like I mean I'm not sure exactly what happened but um.
[AGENT][NEUTRAL] What I can do, Ms. [PII] is if you'd like, I can give you a call back shortly once uh we let this process go through and, and I can receive it uh and, and I can look to see if that we received it and I can give you a call back and verify that for you if you'd like.
[CUSTOMER][NEUTRAL] Well, can you give me? Yes, I would like you to because I, I didn't send it and they should have it by now because it says sent and you can call me back uh on my [PII] line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I did, I did fax it to you all and then I got a, a confirmation today. It says um your claim and additional information has been received and and and I was thinking that.
[CUSTOMER][NEGATIVE] Plus the 17 and 18 pages that the uh therapist gave you and I think from the doctor telling you that she told me to go and apply for social security disability because I'm not getting well quick as quick as I should have and it's just not.
[CUSTOMER][NEGATIVE] Work, the the the uh therapy just not working. It it's just slow, real slow minimum and she told me to go and apply because my back is messed up and then come to find out some other stuff wrong. I got torn rotator cuffs in both of my shoulders, on three spots, and I got frozen shoulder. I can't lift my left arm. My hand has inflammation in it, and then I hurt my knee, my right knee.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Wow, OK. And this is all.
[CUSTOMER][NEUTRAL] And that, that all came from the fall and you know I have diabetes too and I have asthma, I have high blood pressure. I have other things going on with me on top of this injury.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, I'm sorry to hear that you're having such a hard time and um
[AGENT][NEUTRAL] I, I, I do, and I do apologize that you're having to chase this paperwork down, but like I said, um,
[CUSTOMER][NEUTRAL] Yeah, and I'm just trying to pass it.
[CUSTOMER][NEGATIVE] Yeah, and, and I don't, and I don't like that because I'm still having to send stuff over and over again and, and it, it just really, it, it makes me even angrier, but you know I, I'm not gonna have to worry about this no more cause I'm not gonna be able to get uh short term disability because I'm gonna be on disability so I'm not gonna be working so it's no use to them even taking out any more payments out of my account or anything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Cause I'm, I'm, I'm applying for uh disability. The only reason why I haven't applied for it because it's sleet and snowing here in [PII] for me to make it, try to make it down there and I'm not even going outside to even try to fall again for nothing.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, I understand that. I don't blame you. And uh
[CUSTOMER][NEUTRAL] Yeah and it it's just a simple fact, you know, this is the only income that I have I'm getting, you know, and I always got the call and make sure and I don't like that because I'm used to working and I don't like bothering you all just I know like you all don't like us bothering you all, but it's it's just a simple fact you have to keep calling and.
[CUSTOMER][NEGATIVE] Calling. I have bills. I have car notes. I have, I have a car note I have to take care of. I have a house to take care of. People don't understand until you get in that same situation. And I'll be running into people that's so rude to us, but you've been taking my money for years and then when you need the service, it's so hard as hell for you to get and then you get people that don't even wanna, wanna talk to you right.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][POSITIVE] Well, I can assure you that I will keep an eye out for this document and I will call you back as soon as it appears on your file and I'll verify that we have received it, OK?
[CUSTOMER][POSITIVE] Yes ma'am, I wanna ask you something uh ma'am, tell me your name.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Miss [PII], OK, since you know I'm not going back to work, how does it work? Do you just pay me all out?
[CUSTOMER][NEUTRAL] Uh, through cause when is the last payment that I'm supposed to get cause this short term.
[AGENT][NEUTRAL] OK, let me take a look at what your policy allows. Just give me one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so it looks like, um, just to let you know it is a verification of your coverage only, not a guarantee of payment. I do see under the disability, um, you have that 30 day elimination period which is already satisfied and let me, and when did your.
[AGENT][NEUTRAL] Bear with me for one moment.
[AGENT][NEUTRAL] So it looks like the disability uh period is for 6 months, but it does need to be month to month even though we know you're not going back to work. So what happens is um the basically what will happen is once we receive that information, um, when was your last payout was for December, right? [PII], uh-huh.
[CUSTOMER][NEGATIVE] Yes, we haven't gotten anything. I haven't gotten anything for January.
[AGENT][NEUTRAL] OK, yeah, so what will happen is once we receive that information and it's verified, we can go ahead and process the January benefit now um.
[AGENT][NEUTRAL] So it looks like it we had the elimination period satisfied from [PII] and then you received the partial uh benefit for October and then we have November December, so basically you'll have 3 additional months based on what your policy allows is that 6 month benefit period.
[AGENT][NEUTRAL] So you're, uh, you should have that 6 months so you'll have 3 additional months of benefits, um, it's and that's for your policy, um, so like I said, what will happen is we'll process that January benefit and then it will be, uh, you know, it noted that we need to also follow up back with it in February as well so that we go ahead and pay you for that disability period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but like I said, it can't be done upfront unfortunately it does need to go month to month.
[CUSTOMER][NEGATIVE] OK, but you, I won't have to be sending you nothing else in because the doctor didn't tell, that's what I'm trying to see, didn't told you I'm not going back to work. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, and it's like I said, as long as that can be verified, that should be sufficient and then also keep in mind that right now your benefits are paid through January on your premium, so in order to keep this this ability for those additional months we would need that premium.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you have any other questions?
[CUSTOMER][NEUTRAL] Oh, that's all I want you to make sure when you get the, the paperwork that I faxed I emailed to you that you call me back because uh I didn't email it to you now. Thank you.
[AGENT][NEUTRAL] I will.
[AGENT][POSITIVE] Yes, ma'am. I will, I will call you back shortly.
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][POSITIVE] Thank you, Miss [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Talk to