AccountId: 011433970860
ContactId: 1fa35e06-fb11-442d-9df0-94e41a9c8c80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370869 ms
Total Talk Time (AGENT): 167020 ms
Total Talk Time (CUSTOMER): 163034 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/1fa35e06-fb11-442d-9df0-94e41a9c8c80_20250509T17:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], hang on a second. How are you today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm OK, um, I, I need some help with my claim though.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, it's 02540499.
[AGENT][NEUTRAL] OK, can I get your name and your date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I do [PII].
[AGENT][NEUTRAL] OK, thank you. And just need to verify your address and your email address.
[CUSTOMER][NEUTRAL] [PII] and the email is [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And how can I help you with your claims today?
[CUSTOMER][NEGATIVE] I um I'm reading everything and I can't find my past medical history form, uh, and I don't have any idea how to access that.
[AGENT][NEUTRAL] Um, OK. Are you looking at the explanation of benefits you received?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you know what doctor it would have been that, um,
[AGENT][NEUTRAL] That would have that medical history.
[CUSTOMER][NEUTRAL] Well, honestly, I'm not sure what, what you're asking for. I mean, would that be my primary care doctor or the radiologist or?
[AGENT][NEUTRAL] Uh, so it looks like you have a first occurrence benefit for the cancer policy. So, so it would be whoever, um, whoever could, you know, give us the diagnosis and has a medical history, like has your diagnosis on file of that initial diagnosis of cancer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Whether that be your PCP or your oncologist or radiologist, whoever can provide documentation that says that.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Well, but they won't, they don't have my past medical history. Uh, I mean, I, I don't know, they might, but I don't, I hadn't seen them until I was diagnosed. Will they still have my medical history?
[AGENT][NEUTRAL] Yeah, so if like I said for that, it just means that, let me, let me pull it up again real quick.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you, [PII]. I apologize. This is probably simple for you, but my head is swimming.
[AGENT][NEUTRAL] Oh no, I totally understand. Oh, OK, I see this is for pre-existing, so.
[AGENT][NEUTRAL] Um, OK, so who is the doctor that you, that diagnosed you with cancer?
[CUSTOMER][NEUTRAL] Uh, Doctor [PII]. That was the radiologist, I'm sorry, the urologist.
[AGENT][NEUTRAL] OK, so the urologist. So,
[AGENT][NEUTRAL] What we would need is a letter from Doctor [PII] basically saying, has he seen you for this condition before?
[AGENT][NEUTRAL] In the 12 months prior, your effective date. So it looks like your effective date was
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Because you didn't have cancer prior to this date, is that correct?
[CUSTOMER][NEUTRAL] That's correct, yes, ma'am. I was just diagnosed within the past month.
[AGENT][NEUTRAL] OK. OK, so that's what we're looking for. The doctor who gave you the diagnosis, if they can, you know, write a letter stating we, we've not seen him and prior to this for this diagnosis. Did you get a form in your explanation of benefits?
[CUSTOMER][NEUTRAL] Um, well, I, would that have been mailed to me?
[AGENT][NEUTRAL] Yes, it would be mailed.
[CUSTOMER][NEUTRAL] I, I just printed it off of, yeah, no, ma'am, I, I was just looking off the internet. I was confused by the $50 payment and.
[CUSTOMER][NEUTRAL] I mean, as you can imagine, the expenses are starting to.
[CUSTOMER][NEGATIVE] Need and I just didn't understand why I thought I filled out all the paperwork but no I haven't received any email yet is or any letter yet and I just need to wait for that and then have.
[CUSTOMER][NEUTRAL] The urologist on it.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, that's correct. You, you should get it, yeah, you should get it in the mail, probably, I would say probably by Monday or Tuesday at the latest. Um, and then when you get that, you can give that to your urologist. It's this, what, what the issue is, is that your policy has a preexisting condition. So we have to see were you seen 12 months before [PII] for this specific type of cancer.
[CUSTOMER][NEUTRAL] OK, there's nothing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's what we're trying to determine and rule out before we consider the claims and make a payment, so.
[CUSTOMER][NEUTRAL] Yes ma'am I understand. Would it be easier for me to have that to my primary care doctor?
[CUSTOMER][NEUTRAL] Or is it the one that diagnosed me?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It, it can be whoever can attest that you've not been seen for this in the 12 months before [PII].
[AGENT][NEUTRAL] So with, yeah.
[CUSTOMER][NEUTRAL] OK, OK, so if you.
[CUSTOMER][POSITIVE] Yeah, that I think that it'll be easier for my primary care and it'll be easier to get in there too, so thank you very much. I appreciate you, [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, anything else I can help with, Mr. [PII]?
[CUSTOMER][POSITIVE] No ma'am, you've been you've been great thank you.
[AGENT][POSITIVE] OK, well, I hope you have a great weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Yes ma'am you as well.
[AGENT][POSITIVE] Thank you. Bye-bye.