AccountId: 011433970860
ContactId: 162b7c34-83df-41bc-8829-e9287096a092
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1268420 ms
Total Talk Time (AGENT): 376022 ms
Total Talk Time (CUSTOMER): 747890 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/162b7c34-83df-41bc-8829-e9287096a092_20250522T20:11_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in customer service. I have a uh insured calling.
[CUSTOMER][NEUTRAL] Let me give you her policy and we'll start from there so you may need to look at the notes, tell me what I need to do. OK, her policy is 247-7090.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she is [PII], yes, [PII], and look, she works for [PII], so I don't know if that means anything to y'all over there in claims, but it does us over here, you know. Um.
[AGENT][NEUTRAL] Or [PII].
[CUSTOMER][NEUTRAL] [PII] called and left a message for Ms. [PII] to call her back or to speak with anyone in the cancer claims. Now, I don't have a cancer claims queue anymore, I don't think.
[CUSTOMER][NEUTRAL] So would I still send her to the care team like we've been doing for all claims?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Can you see a note that
[AGENT][NEUTRAL] I do. I
[CUSTOMER][POSITIVE] Oh [PII], thank you.
[AGENT][NEUTRAL] Yeah, I understand that.
[CUSTOMER][POSITIVE] OK, wonderful.
[AGENT][NEUTRAL] Um, yeah.
[CUSTOMER][POSITIVE] Alright, um, OK, I have verified all of Ms. [PII]'s information and her husband's date of birth, so everything is good.
[AGENT][POSITIVE] OK, perfect. Thank you so much.
[CUSTOMER][NEUTRAL] And she's just returning [PII]'s call. OK, thank you. Have a good day, dear.
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] Hello, Ms. [PII]. Are you there?
[CUSTOMER][NEUTRAL] Yes. Hi.
[AGENT][NEUTRAL] Hi, it's [PII] on the care team. I was gonna help you with what we were needing additional information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so it looks like we recently got a claim.
[AGENT][NEUTRAL] Um, let me see. Let me get that pulled up real quick.
[AGENT][NEUTRAL] OK, it looks like it's for your spouse, is that right?
[CUSTOMER][NEUTRAL] No, it's actually for my husband.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did I fill out the form incorrectly?
[AGENT][NEUTRAL] No, OK, so what we received, let me get the notes pulled back up, um.
[AGENT][NEUTRAL] What we received, it looks like we need a pathology report that
[AGENT][NEUTRAL] indicates when the cancer was first diagnosed because the progress notes state that it was newly diagnosed and so it, we're just needing clarification on that.
[CUSTOMER][NEUTRAL] If you look at the um
[CUSTOMER][NEUTRAL] Uh, let's see. So in the attachment that I sent, it shows the, uh, notes from the office visit of [PII], and there's 3 pages of that, and on the 4th page, it has the diagnosis.
[CUSTOMER][NEUTRAL] Collected [PII].
[CUSTOMER][POSITIVE] The CD positive.
[AGENT][NEUTRAL] OK, let me pull up what we received. I was, I'm reading the uh claims review on it. Hold on one moment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] There is, I, uh, yeah, go ahead and read, let me know when you're ready.
[AGENT][NEUTRAL] OK, yeah, I see the office visit for [PII].
[CUSTOMER][NEUTRAL] Right, if you look at the, uh, and, and there is one other report, but here's, and, and I can send you whatever you need, [PII]. So, um, uh, [PII] was seen initially if you look on the office visits notes from on the first page of the notes from uh Doctor [PII].
[CUSTOMER][NEUTRAL] The referring doctor was [PII], who was the internal medicine doctor. He ordered
[CUSTOMER][NEUTRAL] Standard annual physical blood work and the laboratory, the, the, the, the laboratory automatically sent his blood sample to pathology because of what they found in that blood. Doctor [PII] ordered the flow cytometry test, which is the test that gives confirmation of the CLL.
[CUSTOMER][NEUTRAL] That test got canceled from Doctor Mall because it had to be ordered by an oncologist. So, um, I, that was when we saw Doctor [PII], we were referred them, made an appointment and saw Doctor [PII], who is the oncologist, and she ordered the flow cytometry which gave that malignant report.
[CUSTOMER][NEUTRAL] Because everything else is just and, and, and this was done by they send it out to the male clinic lab and the male clinic lab accepts those apparently only from a, from a uh oncologist but I can give you.
[CUSTOMER][POSITIVE] Whatever else I, I mean, I can give you all of his lab work. I, I don't know how much of the lab work you need. The flow cytometry is the one that, that though that gives the, the positive.
[AGENT][NEUTRAL] OK, so the, the flow flow cytometry is the one that is essentially the initial pathology, correct? Is that how it
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] The confirmation.
[CUSTOMER][NEUTRAL] That what
[CUSTOMER][NEUTRAL] That, well, the initial pathology talks about all of the um.
[AGENT][NEUTRAL] Possibilities
[CUSTOMER][NEUTRAL] Very exactly right, but there has to be one final but that just gives the suspect. So when Doctor [PII] referred us over from all that lab work, it, it was all worded like.
[CUSTOMER][NEUTRAL] You know, leading to CLL, um, you know, his notes to us were, it looks like it's positive, you need to see an oncologist, you know, and, and everything was leading up to, leading up to, leading up to until we got the tests on [PII] where she where the, where the oncologist ordered the testing and that's where it came in and said.
[CUSTOMER][NEUTRAL] You know, positive and malignant.
[CUSTOMER][POSITIVE] So, um, but again, I'm, I'm OK sending you whatever you need. I, I have no issue with that whatsoever.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you think that?
[CUSTOMER][NEUTRAL] If you need the full.
[AGENT][NEUTRAL] Yeah, I, what I was thinking is, do you think one of your physicians could attest to that this, this is the flow cytometry is the essentially quote unquote pathology report that actually diagnoses the CLL? I think that's where the confusion lies. Usually you're dealing with a piece of tissue and whereas this is blood.
[CUSTOMER][NEUTRAL] Is that right, right, well, that, and, and quite honestly, uh, that's why, you know, like I said, we, you know, we met with her on the [PII], and I didn't, I printed off the claim form that day and I was gonna file it and then I was like, well shoot, there isn't.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] You know, like I, I, uh, through another carrier, I, I report to my sister where it gave a pathology, you know, analysis, malignant tissue, etc. There really isn't anything. As a matter of fact, when we went to Doctor [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That day she looked at us and she said you know why you're here, right? And, and we said well we're thinking we do, but you know, does he, is he positive? Do, do we have CLL? And she said, 00, absolutely. It was the weirdest thing we, we didn't really, there wasn't a.
[CUSTOMER][NEUTRAL] What you got was the pathology report. What I sent was from pathology, but I, I can send you more and if you look on the um on the second page of that office visit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you look way down at the bottom, I highlighted provider visit type is malignant uh uh what do you call it, hematology.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That's the only place I could find.
[CUSTOMER][NEUTRAL] Malignant, that was it and I, and then up at the top, the lesion was newly diagnosed.
[CUSTOMER][NEUTRAL] Chronic lymphatic leukemia. That's it. That's all we could get. And it is a, it is a leukemia.
[CUSTOMER][NEUTRAL] That, um, and this was another reason that I kinda hesitated to file cause I, I wasn't sure what, what to do. It is one that is analyzed only by blood. She said it's the only type of cancer that's monitored and maintained only through blood work. There is no, you know, uh, uh, God forbid it moves um into the bones. There may be bone marrow.
[CUSTOMER][NEUTRAL] Um, biopsies, but she said at this point, they don't see any reason to treat it at all, that his blood is totally abnormal and he has CLL, but there's no reason to treat it. We go back June.
[CUSTOMER][NEUTRAL] Uh, [PII], I think it's on here we follow up again.
[CUSTOMER][NEUTRAL] [PII] and he does blood work again and we meet with her and if everything stays the same, we.
[CUSTOMER][NEUTRAL] Go with no treatment. Again, we, we just have regular, um, she said you'll have blood work every 3 months for the rest of your life uh and no treatment unless something occurs that, that, that demands a treatment.
[AGENT][NEUTRAL] Right, um, yeah, I think.
[CUSTOMER][NEUTRAL] So I'm I.
[AGENT][NEUTRAL] I think what would be probably best on our port if, so whatever doctor could attest to the flow cytometry analysis is the.
[CUSTOMER][NEUTRAL] So I'm not.
[AGENT][NEUTRAL] That is what is utilized to diagnose the cancer.
[AGENT][NEUTRAL] Um, you know, again, we're not dealing with tissue, so I totally unders it's different cause it's blood. So I'm not sure that even if you sent the lab work in, it may, I, I don't wanna, I don't wanna waste your time and then we, it doesn't suffice. So I think that's the distinguishing factor that we need a healthcare provider to say, you know, this is, this is the test to determine this cancer.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Well, it does, but I'm not sure how I get that. Um, but I, I, I certainly, you know, I would, I would think that the notes from her with, you know, newly diagnosed.
[CUSTOMER][NEUTRAL] Leukemia, you know, and malignant.
[CUSTOMER][NEUTRAL] Hematology, but I, I'll do whatever and CD 5 positive B cell lymphorolific disorder.
[AGENT][NEUTRAL] OK, let me, let me check real quick on something else. Do you mind if I put you on a brief hold?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] No, not at all. And, and I thought, you know, like I said, [PII], if I need to get it, I'll get whatever you need.
[AGENT][NEUTRAL] OK, let me put you on a brief hold real quick, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. I wanted to get your input on this claim that I'm looking at. Um, I think, what's your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK. Who's [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Possibly is is that [PII] or [PII].
[AGENT][NEUTRAL] [PII], that's it. OK, well, maybe you can help me though. This one's kind of funky because we're looking at a cancer claim and it's not, uh, let me give you the policy number if you don't mind.
[CUSTOMER][NEUTRAL] Certainly, go ahead.
[AGENT][NEUTRAL] 247-7090.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is one of uh
[AGENT][NEUTRAL] [PII]'s [PII]ustomers, so I know he's one of our heartbrokers, um, trying to help her out and figure out what we can do. Um.
[AGENT][NEUTRAL] Uh, OK. So, so her husband's been recently diagnosed with a leukemia. OK. And so we have a note in there that we need the pathology report, but because it's leukemia, which is a blood cancer, there is no pathology report, like they don't do tissue. They only determine the cancer by way of a blood test.
[AGENT][NEUTRAL] Um, which is what she submitted.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Sorry about that, um, [PII], what's that policy number again? I couldn't pull it up 02.
[AGENT][NEUTRAL] 0, uh, 247-709-0.
[CUSTOMER][NEGATIVE] That's what I put in it's not coming up.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] Could be, you know, something's wrong with my line and one of them spinning around and I opened another one and now it's giving me some funky message.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] We
[CUSTOMER][NEGATIVE] Yeah, I'm not, it's not moving for me.
[CUSTOMER][NEUTRAL] Bear with me for just a moment let me see if I can open another window. I don't know what's going on with it.
[CUSTOMER][NEUTRAL] I'm getting a weird message saying some kind of internal error.
[CUSTOMER][NEUTRAL] Session was timed out so.
[AGENT][NEUTRAL] Uh
[AGENT][NEGATIVE] And we, yeah, I've had problems there with line too sometimes it's funky.
[CUSTOMER][NEUTRAL] I don't know what's going on, sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well they're doing there's a lot of behind the scenes stuff going on too so.
[AGENT][NEUTRAL] I know, yeah.
[CUSTOMER][NEUTRAL] I guess that's understandable.
[CUSTOMER][NEUTRAL] OK, I got it. [PII], right?
[AGENT][NEUTRAL] Yep, and it's for [PII].
[CUSTOMER][NEUTRAL] For part two, yep, OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Just wanted to get your opinion on this because it's not, so it's leukemia and it's blood cancer, so it's not an actual like tissue pathology report that diagnoses the cancer. It's the flow cytometry, which she attached. So basically how she explained it is.
[AGENT][NEUTRAL] You know, he went in, they did a bunch of lab work.
[AGENT][POSITIVE] You know, he came back with abnormal lab work, blood work, and then this flow cytometry is the one that is the definitive.
[AGENT][NEUTRAL] says, yes, you've got leukemia.
[AGENT][NEUTRAL] So it's not
[CUSTOMER][NEUTRAL] I'm pulling up the documents.
[AGENT][NEUTRAL] Not an actual pathology report of tissue, it's a blood.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Test, that is the, you know,
[AGENT][NEUTRAL] The final test that determines, you know, definitively this is.
[CUSTOMER][NEUTRAL] Like what page or.
[AGENT][NEUTRAL] Oh, sorry, uh, page.
[AGENT][NEUTRAL] Uh, it's page 7.
[AGENT][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] Well, now, [PII] has a note in here this, this morning, she called the patient. Phone insured, no sign claim form, no answer. Insured needs to submit pathology or blood specimen report that first diagnosed the cancer. So she did reach out and try to contact the patient regarding this, and that was [PII]'s note on the claim. When I pulled up the claim documents, she's got a sticky note on there. So she's saying that that's what's needed.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, so there's another blood specimen uh test, I guess then that.
[CUSTOMER][NEUTRAL] That's what she's saying, the blood specimen report that first diagnosed the cancer.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'll see then if she can, it's just the member was saying that this is the one that actually says, yes, he's got the CLL, whereas the other ones are just saying abnormal, abnormal, we need to.
[AGENT][NEUTRAL] You know, look further or whatever. So I'll see if she has.
[CUSTOMER][NEUTRAL] You said mm.
[CUSTOMER][NEUTRAL] Right. And then she's got another note on here actually just at [PII], new patient lymphoma clinic, newly diagnosed with chronic lymph uh lymphocytic leukemia needs a pathology report for that first diagnosis diagnosis of cancer.
[AGENT][NEUTRAL] OK, I'll see if she can send the other. I don't see the sticky note. Where's the sticky note?
[CUSTOMER][NEUTRAL] So there's
[CUSTOMER][NEUTRAL] I pulled up the claim documents associated with that claim that was processed, the 36045997.
[CUSTOMER][NEUTRAL] Which was the
[CUSTOMER][NEUTRAL] Latest claim number.
[CUSTOMER][NEUTRAL] I pulled up the documents in OnBase and and when you pull it up that way you'll be able to see the sticky notes if you do it from the hyperlink and Lion it doesn't show you those notes and sometimes you have to search for them if they're available but I've noticed this the screen is a little wonky.
[CUSTOMER][NEUTRAL] So when I wanna look at the documents I go to Onase and pull it up by that mail number because then you can see the whole picture and you can also put it in by it it's also if you're looking just like for an FYI if you're looking for like an email inquiry or something like that, any uh any documents that we might have received, you can look at them through Onase by putting in just the policy number and it'll bring up all the documents attached to that uh to that policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, perfect. Well, I didn't know that. No wonder I can't see it. Well, I'm gonna have to look, um.
[AGENT][NEGATIVE] What are you talking about? I don't see what you're talking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] OK, perfect. OK, I'll let her know to submit the original lab work, um, and then we can go from there. OK, thank you so much. I appreciate you.
[CUSTOMER][POSITIVE] Yeah, and that's right. No problem, anytime, [PII].
[AGENT][POSITIVE] OK thanks bye.
[CUSTOMER][NEUTRAL] All right bye.
[AGENT][NEUTRAL] OK, I'm so sorry. Thank you so much for your patience. I appreciate it. um, OK, yes, and can you submit the original lab work? That's, that's what we're needing to see. So the original lab work, um, if you can submit that, then we can review that, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All of the, like all of the, the, the like I'm looking at it the, you know.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He had and and do you want it from.
[CUSTOMER][NEUTRAL] That date from, from the oncologist or do you want it from?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The internal medicine doctor. That was [PII] was the first.
[CUSTOMER][NEUTRAL] Blood work, when he went for his annual physical, that was the first blood work that showed a problem and then um
[CUSTOMER][NEUTRAL] He referred us to the oncologist that we were not able to see until March.
[CUSTOMER][NEUTRAL] Um, and then she did the work again, so which do you want?
[AGENT][NEUTRAL] Yes, young.
[AGENT][NEUTRAL] The oncologist.
[CUSTOMER][NEUTRAL] Oh, OK. All right. And listen, I just Googled what test gives a positive diagnosis of CLL.
[CUSTOMER][NEUTRAL] And according to two sources, it says the flow cytometry.
[AGENT][NEUTRAL] OK. Um, yeah, I think we just, when we, when we have that piece of the original lab work from the oncologist coupled with what you've submitted already, um, that should suffice, so.
[CUSTOMER][NEUTRAL] But um
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, let, and let me see how I can print off all these because they did a bunch of them. I'll have to see how I can print them off of the website, um.
[CUSTOMER][NEUTRAL] I'll, I'll, I'll do it and then just upload it through the um OSC.
[AGENT][POSITIVE] Yes, perfect. Yeah, that would be, that would be perfect.
[CUSTOMER][NEUTRAL] OK. And I, I think based on what I had, had, you know, outlined is that there is, they aren't planning to treat it. The only, the only benefit available would be the initial diagnosis if, if it's approved, right?
[AGENT][POSITIVE] Yes, that's correct, yeah.
[CUSTOMER][NEUTRAL] OK, OK, doke. Well, let me see what I can do to get these printed off and I'll send all the lab work from the [PII], which there's a whole bunch, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, that would be perfect. And thank you so much for your patience. I appreciate it.
[CUSTOMER][POSITIVE] Oh, no worries at all. Thank you.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a good evening.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you. You too. Bye.
[AGENT][POSITIVE] Thank you. Bye bye.