AccountId: 011433970860
ContactId: f4145445-1b40-4b7d-9d99-8fd87ff9f7c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1346680 ms
Total Talk Time (AGENT): 457900 ms
Total Talk Time (CUSTOMER): 424019 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/f4145445-1b40-4b7d-9d99-8fd87ff9f7c1_20250226T19:40_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, um, I was just looking for some more, um,
[CUSTOMER][NEUTRAL] Information about my process short term disability claim.
[AGENT][NEUTRAL] OK, so you have filed a short term disability claim, is that correct?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, um, and
[AGENT][NEUTRAL] And you
[CUSTOMER][NEUTRAL] I need to appeal the decision and I just needed more information on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What the reasoning was um part of the insurance company for their decision.
[AGENT][NEUTRAL] OK. Mm.
[AGENT][NEUTRAL] OK, so you're wanting to get the denial reason for a claim that we reviewed, is that correct? So that you can file an appeal?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who was?
[CUSTOMER][NEUTRAL] Well, I know it was like pre preexisting, but like, like what else do I want to know?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, well, there should be a letter coming. We'd like a copy of the letter emailed to you. Yeah, is it possible to get a copy of the letter emailed to me so that I can deal with it faster?
[AGENT][NEUTRAL] OK, what letter are you referring to?
[CUSTOMER][NEUTRAL] The letter that
[CUSTOMER][NEUTRAL] Uh, this morning someone told me there was gonna be a letter that came about my claim saying that it was denied.
[AGENT][NEUTRAL] OK, yes ma'am. I can help you with this, but I will have to pull up your policy information first and verify some information, several things with you for security. So who am I speaking with, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you. And Ms. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, 250-0346.
[AGENT][NEUTRAL] OK, thank you, so give me a moment please to get your information pulled up.
[AGENT][NEUTRAL] OK, Ms. [PII], so any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. First off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address and this does appear to be a work email address that's on file for you.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you so much. OK, so Miss [PII], are I see that you do have your profile set up in the APL online service center.
[AGENT][NEUTRAL] Where you can log in for the claim number you can actually access your explanation of benefits which is what you would be receiving in the mail.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, really?
[AGENT][NEUTRAL] In your portal, yes, ma'am, uh huh.
[AGENT][NEUTRAL] And on the 2nd page of the explanation of benefits, it has the remark regarding the denial.
[AGENT][NEUTRAL] Do you already have the claim number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I don't understand.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Where do I find that in the portal?
[AGENT][NEUTRAL] OK, so when you log in, you're gonna see where it talks about claims.
[AGENT][NEUTRAL] Claim status?
[CUSTOMER][NEUTRAL] Well, when I log in it says APL my coverage, my ID cards and then it says my claims.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Well, uh-huh, so that's where you're gonna go.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you will see the claim number 355-7107.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Uh, there it is, Queen number. Oh, and it's all the way over stupid.
[AGENT][NEUTRAL] And so you just click on that claim number and it will open up your explanation of benefits and again your comments are on the 2nd page.
[CUSTOMER][NEUTRAL] OK, it says it's getting my file.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is so.
[CUSTOMER][POSITIVE] It's taking its time.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Now, are you trying to do that from your phone or from the computer?
[CUSTOMER][NEUTRAL] From my phone.
[AGENT][NEUTRAL] OK, it's proba it may not load it from your phone. You would have to, may have to do that from a computer.
[AGENT][NEGATIVE] The mobile functionality is limited like you cannot upload documents from your phone into the portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, you can, cause I did.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Well, that's interesting, OK.
[CUSTOMER][NEUTRAL] Can you grab me that computer?
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Sorry, I'm getting the computer.
[AGENT][NEUTRAL] Oh, no, you're fine. Yeah, no, ma'am, you're fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you said to the examiner earlier today, did they get, they went over the remark with you on your denial?
[CUSTOMER][NEGATIVE] No, no, no, no one, no.
[AGENT][NEGATIVE] She did not.
[CUSTOMER][NEUTRAL] No, I didn't see anything of the, of the letter.
[AGENT][NEUTRAL] OK, well, it's a, it's not a letter. It's, it's the explanation of benefits from APO. It's not actually a letter.
[CUSTOMER][NEUTRAL] I'm, I'm con
[CUSTOMER][NEGATIVE] It's gonna take forever
[CUSTOMER][NEGATIVE] Now I'm gonna have to reset the password.
[CUSTOMER][NEUTRAL] Are you looking to
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] What about people who don't have a freaking computer?
[AGENT][NEUTRAL] Well, again, this is male. They're all mail.
[AGENT][NEUTRAL] In addition to being able to be also available online.
[AGENT][NEUTRAL] Is it still not downloading for you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Well, no, it's just that now I need to go through the whole process of.
[CUSTOMER][NEUTRAL] Maybe I should just call back.
[AGENT][NEUTRAL] Yeah, I mean, what can
[CUSTOMER][NEUTRAL] Because now
[AGENT][NEUTRAL] No, ma'am, go ahead. How can I help you?
[CUSTOMER][NEUTRAL] I don't know that you can because now I, I just, I just got a computer but it's not my computer and I just have to go through a login process.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] I also have
[CUSTOMER][NEUTRAL] All the stuff like
[CUSTOMER][NEGATIVE] And then I'm gonna have to probably reset a whole bunch of passwords and to get.
[AGENT][NEUTRAL] What I can do.
[AGENT][NEUTRAL] I can go ahead and I will email it to you at to the email address that we have on file for you.
[AGENT][NEUTRAL] And you should be able to, you can uh.
[CUSTOMER][POSITIVE] That would be, that would be really helpful.
[AGENT][NEUTRAL] OK, since you're having to use a whole different um computer and everything, so yes, ma'am, I'll go ahead and attach a copy of your explanation of benefits.
[AGENT][NEUTRAL] And the email is going to come from [PII] and I will put APL and then explanation of benefits in the subject line for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else, Ms. [PII], that I, and you should have that in just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have sent that to you, so you should be receiving it anytime or you may already have it.
[CUSTOMER][NEUTRAL] And stuff is just loading.
[CUSTOMER][NEUTRAL] Can you make it bigger?
[CUSTOMER][NEUTRAL] OK, I have it.
[AGENT][NEUTRAL] You do have it? OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I understand based on the notes from your conversation earlier today that they explained the appeals process and the timeline for filing an appeal.
[CUSTOMER][NEUTRAL] Filing uh the timeline, now.
[AGENT][NEUTRAL] OK, so an appeal must be filed within 180 days from the date of the decision.
[AGENT][NEUTRAL] And it must be submitted in writing. And did they provide you the address to send that to?
[CUSTOMER][NEUTRAL] No, they only gave me a fax.
[CUSTOMER][NEUTRAL] Um, but is there an actual address?
[AGENT][NEUTRAL] Yes ma'am, you would send it to [PII].
[CUSTOMER][NEUTRAL] Wait, wait.
[CUSTOMER][NEUTRAL] What is it?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Attention appeals department.
[CUSTOMER][NEUTRAL] And it has to be.
[CUSTOMER][NEUTRAL] Within 180 days.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh, from the date it was processed and that process date was [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then she said it should be a letter stating why I disagree with the decision on the.
[AGENT][NEUTRAL] Yes ma'am, any supporting documentation that you want to provide for us for it to be, you know, considered.
[AGENT][NEUTRAL] You may include in your appeal. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. Well, is there any?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Wait, wait, I just have someone with me, um, ask a question. I, I want to read through these remarks with you because all it really, let's see what it says here because we may have further questions.
[AGENT][NEUTRAL] And who am I speaking with?
[CUSTOMER][NEUTRAL] This is my mom.
[AGENT][NEUTRAL] And your, um, what is your
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, let me see if I can services. OK, so it says no disability will be payable if disability is caused by or resulting from a pre-existing condition. The limitation will not apply to a disability resulting from a pre-existing condition that begins after you have been continuously covered under the policy for 12 months.
[AGENT][POSITIVE] Good
[CUSTOMER][NEGATIVE] Based on the claim, OK. So what I, wow, that is the like completely indecipherable.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I this doesn't really help because it doesn't say.
[CUSTOMER][NEGATIVE] It, it doesn't say what you're looking at that's causing you to think this.
[CUSTOMER][NEUTRAL] I, I have no idea what why you're, why this is being denied because you don't really say anything other than what's in the policy itself. So what particular part of this application and claim do you not do you think is a preexisting condition because there were many things going on that happened after the the policy was taken out.
[CUSTOMER][NEUTRAL] Like, um, GI problems, um,
[CUSTOMER][NEUTRAL] Mobility problems, uh, eye problems, all kinds of things that were, that happened after.
[CUSTOMER][NEUTRAL] But you say nothing about what in particular you're concerned about. You just said it's pre-existing.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Yes, ma'am. Based on the information I that I can provide and also Ms. [PII], do you authorize me to divulge any information on this one phone call only?
[AGENT][NEUTRAL] With your mother?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. All I can do is provide you the same information that you're reading that there is a pre-existing, a limitation will not apply to a resulting um apply to a disability resulting from a pre-existing condition that begins after
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You have been continuously covered under the policy for 12 months.
[CUSTOMER][NEUTRAL] OK, let's go back to my original question though. Who do I talk to or how do we, how do we find out what specifically you're talking about in the in the claim?
[AGENT][NEUTRAL] Yes, and we
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK. I, I.
[CUSTOMER][NEUTRAL] There are many different things in that claim, which one is it that you are basing this denial on?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, again, I can transfer you over to one of the examiners. I know that um,
[AGENT][NEUTRAL] [PII] talked with one of them this morning, earlier today regarding this claim, but I'll be happy to try and connect you all to see if they can look. I'm only able to provide you the information that I can see on the remark.
[CUSTOMER][NEUTRAL] OK, um, did you? I did. I thought it was the same person. OK, so she called the same number that she just called and got you. So how, how do we know that this was someone who actually had more information?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] And then explain the appeals process. Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Because I can see the notes. Yes, ma'am. I can see the notes for the, for who spoke with her this morning.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so apparently this was someone who has more information than what you're able to provide.
[AGENT][NEUTRAL] Yes, ma'am, again, based on the information that has been reviewed, the determination was made that this was considered a pre-existing condition.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, but we need to understand better what you're looking at that's causing this because as I said.
[AGENT][NEUTRAL] Because this policy went into effect [PII].
[CUSTOMER][NEUTRAL] Well, I know that I know that, but uh if you, what I'm trying, what I'm trying to say.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Is that there were many coolly.
[CUSTOMER][NEUTRAL] There were many different things in the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Would cause that would cause this leave of absence from her work.
[CUSTOMER][NEUTRAL] And not just one, and yes, I think there's one thing that was um start that they started to treat before [PII], but there are numerous that happened after [PII]. I need to know.
[CUSTOMER][NEGATIVE] Why you have denied this based on.
[CUSTOMER][NEUTRAL] All of the things that happened after [PII].
[AGENT][POSITIVE] OK. Again, I'll be happy to try and connect you over, Ms. [PII], with one of the examiners.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] To go over this additionally with you. And again, you do have the 100.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Um, what was your question? And then, what was your question?
[CUSTOMER][NEUTRAL] My, my question is when we if we have to call back, what number would we be calling?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] The same one that you should have been the one that you called in on today?
[CUSTOMER][NEUTRAL] OK, so who should we ask for then if it's not you?
[AGENT][NEUTRAL] It's all going to go through the same, it's all gonna go to the same location.
[CUSTOMER][NEUTRAL] If it's
[AGENT][NEUTRAL] And then it will get routed if a, you know, properly, if it has to be transferred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, alright, thank you. So yes, please transfer.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[AGENT][NEUTRAL] OK, so Ms. [PII], are you still on the line, [PII]?
[CUSTOMER][NEUTRAL] Oh yeah, I'm here.
[AGENT][NEUTRAL] OK. So yes, ma'am. You'll need to remain on the line. And is there anything else I can help you with before I transfer you?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope that you have a very nice rest of your day, OK? So give me just one moment and I will get you connected.
[CUSTOMER][NEUTRAL] know agent staff. Goodbye.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] One moment, I'm gonna have to place you on hold for just a moment, OK?
[CUSTOMER][NEUTRAL] OK um alright.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Why are there no agents available?
[AGENT][NEUTRAL] Hmm.