AccountId: 011433970860
ContactId: e38a642c-657e-4580-81b1-5b396acd714c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 429619 ms
Total Talk Time (AGENT): 242585 ms
Total Talk Time (CUSTOMER): 170519 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/e38a642c-657e-4580-81b1-5b396acd714c_20250319T21:03_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you. No. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] You like the chicken oh.
[CUSTOMER][NEUTRAL] Hello, um, my name is [PII]. I wanna call to check on my claim. Um, my social is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I was told that you all received the additional documents that was, that was required, and I just want you to document that I am requesting this in the event I am denied for any reason, I would like to have proof of the whatever ailments they were looking for in medical records or whatever. I need a proof of a diagnosis.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] All right, this is, is this on a um disability claim or?
[CUSTOMER][POSITIVE] Correct. Short term disability.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They said they're gonna work on everything today. She called me back and she said, I didn't want you to think you're gonna be getting a check right now because what we have to do is we have to send for medical records or whatever. I was like, OK, that's fine, so.
[CUSTOMER][NEUTRAL] Um, as far as me being treated a year prior or whatever, whatever you guys' rules and guidelines were, didn't read that in the policy, by the way, but um, if I am prove, proven ineligible for to finish it, I want proof.
[AGENT][NEUTRAL] All right. And do you mind verifying your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can you verify your current mailing address?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] All right, thank you. And your uh good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so let me get everything pulled up.
[AGENT][NEUTRAL] Oh, I see you've been trying to get this for a while. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, yes, I've been on them. They sent, they faxed over to the doctor. Megaforest, the lady Mega Force says, Oh, I'm sorry, I don't know how to fill it out. My supervisor won't be back till Monday. I said, no, no, no, no. Cacorporate. I said, Hey, one of your employees don't know how to do the job correctly, can we send it? Can I get you to send it directly to you? And she said, no, not a problem. Have them send it right over, so.
[AGENT][NEUTRAL] That's why
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Yeah, I've been on it.
[AGENT][POSITIVE] Wow.
[AGENT][POSITIVE] You have. I'm proud of you, [PII].
[CUSTOMER][NEUTRAL] Me too. I probably me too.
[AGENT][NEUTRAL] You were staying on it.
[AGENT][POSITIVE] That's good. That's important and you have to sometimes be your own advocate, but we're gonna do everything we can to help you as well. Um, just, of course, you know, just needing those certain documents, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me check. I'm just checking on it for you. Hang on just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I knew you'd call before cause you spit out that social like you knew what you were doing.
[AGENT][POSITIVE] For sure.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So, OK, so you faxed in something.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] I do see a document that there's still some documents that they're still reviewing.
[AGENT][NEUTRAL] And so just, just to make sure I'm going to put in the notes that once the claim decision has.
[AGENT][POSITIVE] Been made. Now you know you're gonna get a copy of an explanation of benefits.
[AGENT][NEUTRAL] Even with the payment, so I see your direct deposit is active. If they can pay the claim, they're still gonna email you a copy with the claim decision.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEGATIVE] Is that gonna be a exact we found that blah blah blah and this is why we're denying you because and in exact details why because I want exact specific details which is probably more they normally send out.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is more than they send out so here's what I would suggest to you.
[AGENT][NEUTRAL] Because um.
[AGENT][NEUTRAL] You know, of course they won't know until and.
[AGENT][NEUTRAL] It's processed. If there's a payment, you know, then they're, they're not gonna give you the, this, the cause for your disability or a, a reason to deny it. But what I would suggest, Ms. [PII], I know exactly what you're asking for and I understand why.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, I would, once it's processed.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Then call back and tell them you want to know the exact reasons that way you can talk, just ask them, you know, ask to speak to the adjuster.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Or an adjuster, and they can go through those medical records and tell you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] You know, exactly, and give you more detail.
[AGENT][NEUTRAL] On the claims.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Adjuster, OK, that's when I'm ready.
[AGENT][NEUTRAL] Yeah, that's what I would suggest now I'm gonna put it in the notes that you want to know, but.
[CUSTOMER][NEUTRAL] Yes, yes, so that they do not.
[AGENT][NEUTRAL] That way you get specific, yeah.
[CUSTOMER][NEUTRAL] Except that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if they, you know, they might happen to miss it in the notes, you know, and not provide that for you that's why I'm saying.
[AGENT][NEUTRAL] To get that information I would suggest calling after the claim has been processed and then speak to an adjuster.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let them give you that information.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] See how far they are in the process right now. You can only see that's what it's been scanned in.
[AGENT][NEUTRAL] Right, all I can see is that there are some documents that looks like that they are reviewing. It looks like they've been reviewing several of those documents today.
[AGENT][NEUTRAL] Uh, medical records for Doctor [PII]? Sorry, I don't know how to say it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yes, [PII], yeah, 3 years to learn how to.
[AGENT][NEUTRAL] Yeah, that one.
[AGENT][NEUTRAL] OK. So, um, that's what I would suggest that, that way you know you're gonna get your answer.
[CUSTOMER][NEUTRAL] Yep, yep
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] OK great great great.
[AGENT][POSITIVE] And I understand. I'm, I'm proud of you for taking, taking care of things and staying on top of it. A lot of people don't.
[CUSTOMER][NEUTRAL] So the OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yes, take me forever, but
[CUSTOMER][NEGATIVE] It's, it's gonna take me forever and, and, and, and, and no is not exceptional for me. So if they do say no, I need to know specifically why so I can backtrack and be like, hey, you're not supposed to do that.
[AGENT][NEUTRAL] Right. And, and just remember in the back of your mind, you uh there's, you always have a right to an appeal on an insurance decision. That's with any company, so you've got that right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So don't forget that.
[CUSTOMER][POSITIVE] Now appeal, appeal, appeal, appeal all day. OK, thank you so much for.
[AGENT][POSITIVE] But you know, and it may be paid. You may not even have to worry about an appeal, you know. Once we get those documents and they review it, that's all they're waiting on are the specific documents, and then you could, uh, you know, the payments could go through and everything would be fine. You wouldn't have to worry about them, um, about an appeal.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I hope it's
[CUSTOMER][POSITIVE] Thank you. Have a good day.
[AGENT][POSITIVE] I hope you do too, Ms. [PII]. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] All right bye.