AccountId: 011433970860
ContactId: e48ec138-b6a2-4637-a67e-cca36a9781f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 738210 ms
Total Talk Time (AGENT): 249073 ms
Total Talk Time (CUSTOMER): 307550 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/e48ec138-b6a2-4637-a67e-cca36a9781f0_20250217T21:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, [PII], um, I, I, I submitted some paperwork so that I could, uh, um, get the information on behalf of a claimant.
[CUSTOMER][NEUTRAL] Um, I work in the broker's office for the group, and this time just needs some help getting their disability.
[CUSTOMER][NEUTRAL] Uh, claims, um, claim, well, they've got one payment and then just we need to find out what else is required to get the next payment.
[AGENT][NEUTRAL] OK. And your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], do you have that policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] It is 230-1502.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the insured's name, date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] Date of birth is um [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] So that you spoke with the representative. Give me one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK sure we received the claim.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, we received the authorization form.
[AGENT][NEUTRAL] And I do show we receive.
[AGENT][NEUTRAL] The insured portion of the claim form, but I don't see the, the physician. Let me double check. Give me one moment.
[CUSTOMER][NEUTRAL] Oh, OK, so, well, yeah, so, uh, no, you don't have a physician update, I guess is that I, I don't know exactly what's needed. It, it did they send they told me there was an explanation of benefits sent.
[AGENT][NEUTRAL] Uh, yes, an explanation of benefits was sent along with um.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] A claim that the insurer will need to fill out and the um physician will need to fill out.
[CUSTOMER][NEUTRAL] OK, so it's the exact same claim form that's already been submitted and you're saying it has to be updated?
[AGENT][NEUTRAL] Yes, it's a this, um, since this is a continuing disability, uh, she would have to finish or complete the continuing disability portion of the claim form and we need the physician's portion of the form.
[CUSTOMER][NEUTRAL] OK, so, uh, uh, what, what, OK, so now, OK, so that, that's all the explanation of benefits says I guess is that because they said I would get, I, I, I was hoping to get my eyes on that just because I, I'm just to make sure I understand what I'm getting, but that's, that's, is that all it says basically.
[AGENT][NEUTRAL] Uh yes, sir, and with along with the EIB that was sent, uh, they also sent the form, but it can, um, if the insured wants it sooner, we do have the form available on the website.
[CUSTOMER][NEUTRAL] No, I think I have the form. It's just the regular claim form is what the regular 8 page claim form.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, it should be continuing disability claim form and I think it's from sections A through E. Um, if you look at the form, it does have at the bottom section F like initial disability, and then it has a section G which is continuing disability.
[CUSTOMER][NEUTRAL] OK, well, let's, let's let me put my eyes on that. Give me just a second here.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because I don't, I've not noticed the difference yet, but that, that this is my first time to ever do this, so.
[AGENT][NEUTRAL] Oh, no, I understand. Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, so let's see here, OK, so.
[CUSTOMER][NEUTRAL] OK, so section F initial disability ts, OK, section G continuing.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Disability
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so we really shouldn't have filled out the initial one, but I that was not a big deal I guess it was already there.
[AGENT][POSITIVE] No, and then it looks like they uh filled out section G, so that's good.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, OK, and then, and then we need to have.
[CUSTOMER][NEUTRAL] Yeah, so this is just the standard. Yeah, I, I see what you're saying now. OK, so this is just the standard claim form. We only need to do section G, um, now the original one was dated [PII], so is that what they paid through, I guess.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Yeah, no, wait.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that's the reason why if she's got longer than expected, that's the reason why they're needing the physician's port portion of that claim form, um.
[AGENT][NEUTRAL] If it's showing that she's out longer than expected.
[CUSTOMER][NEUTRAL] Well, yeah.
[CUSTOMER][NEUTRAL] Well, no, it was long. I, I, uh, let me see here. Let me read the.
[CUSTOMER][NEUTRAL] I have the original the original claim form hang on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the original claim form this this the attending physician statement.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You get the high diagnosis codes.
[CUSTOMER][NEUTRAL] And then it um.
[CUSTOMER][NEUTRAL] And then it says if if in how many months do you expect a fundamental change in patient's conditions and the 2 is checked off.
[CUSTOMER][NEUTRAL] The 2 months.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is the patient able to work in occupation while disabled? No.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And they the most recent treatment was February 3rd patients on the care date nextpointment February 5th. I mean she's got a facility. It can't work, um, and so you're saying y'all needed something. I mean, what do y'all need that is more than this, I guess.
[AGENT][NEUTRAL] Uh, just the physician's portion of the form, if it's going to show that she's out longer. Give me one moment, let me look at the form, see what I have on here. Uh, patient is still under your care date of next appointment, which shows February 5th.
[CUSTOMER][NEUTRAL] Is this
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, that was literally.
[CUSTOMER][NEUTRAL] The day that they was the day they faxed it.
[AGENT][NEUTRAL] I understand what you're saying as far as the extent of the disability they mark 2 months, but since they're showing that she has um an appointment date on the [PII], that's the reason why they require the physician's portion of the form if it's gonna have her out longer than the [PII] from.
[CUSTOMER][NEUTRAL] Well, I mean, she, she's seeing a doctor, she's seen a doctor almost every day. I mean, she's she, she, she's basically had a stroke. She's like seeing a doctor every day. Yeah, so, so.
[AGENT][POSITIVE] Oh, bless her heart.
[AGENT][NEUTRAL] Yeah, so we would just need their portion of, well, then they would just need to um submit their portion, fill out their portion of the form and submit that to us.
[AGENT][POSITIVE] Oh my gracious.
[CUSTOMER][NEUTRAL] OK, OK, well, well, it's the same form and it's basically no change, but I I'll, I'll, uh, well, it's a different doctor now. She's moved, she has moved facilities, so I will, uh, uh, we will pursue a physician's statement.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's so hard. Well, I hope she feels better.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Well, yeah, she can't check her mail so it it's uh he's asking me how this works and I've really never had to help people because usually you guys are really helpful but and um um and so this one's just a little bit different that way so um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I, you know, uh, yeah, yeah, I will say I was a little surprised y'all didn't pay a little bit further because it's, it's clear that she's still, still, still disabled, but, uh, we'll, we'll get it, we'll, we'll, um, and so like I mean somebody explained to me, I usually pay a monthly amount. So if we give you a statement, it says the next appointments tomorrow, you're only gonna pay through tomorrow or how's that work?
[AGENT][NEUTRAL] Well, on the physician's portion, it will say when she is expected to return and then they can go by that if she's out for.
[CUSTOMER][NEUTRAL] They got they left that blank so I guess that's the problem.
[AGENT][NEGATIVE] Longer, 2 months.
[CUSTOMER][NEUTRAL] Is that what you're saying? I mean I don't think they really know when she's gonna return. She could be out 2 or 3 months.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, if, because there's a 3 month, um, disability period on the plan, so she's gonna be out longer than 3 months, well, then the max, but if she's longer, uh out longer than the 2 months that they have listed, then
[AGENT][NEUTRAL] That could affect the benefits too, so they just need a physician's portion because of what they place on there as far as her next appointment, I guess to evaluate if she can return to work, but if she's still in the hospital, then they would just need to submit that updated updated portion of their form.
[CUSTOMER][NEUTRAL] Oh, I understand that.
[CUSTOMER][NEUTRAL] OK, well, I unfortunately the doctors don't call me to say how do I fill this out.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, well, we'll try the.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'll try to get you an updated form.
[AGENT][NEUTRAL] OK. Um, well, is there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Well, what you can, what you could do is get them just to process another payment based on this form, but I guess that's not happening.
[AGENT][NEUTRAL] No, sir, since they're requesting it.
[CUSTOMER][NEGATIVE] So she needs the money because she, she, she, you know, she was, she wasn't really functioning for the first couple of weeks and so, you know, well, you know, so we couldn't even pro she didn't even, you know, and what also happens is now she's functioning pretty good. She starts calling her the employer and I've been called 3 people over there, 4 people, and everybody gets all worked up and it's making us all look bad.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, so, so, uh, and, and then I, I, I don't, you know, and then I don't have direct connection to the doctors and so to get them to fill out the form properly, so hopefully she'll be able to do that. So, OK.
[AGENT][NEUTRAL] Ah
[AGENT][POSITIVE] All right. Well, uh thank you for calling APL. You have a great day.
[CUSTOMER][POSITIVE] OK great thank you bye bye.
[AGENT][POSITIVE] Thank you, sir. Bye.