AccountId: 011433970860
ContactId: 2c60807c-1878-4ebd-af9e-9cfccac97f13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 665280 ms
Total Talk Time (AGENT): 229022 ms
Total Talk Time (CUSTOMER): 327030 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/2c60807c-1878-4ebd-af9e-9cfccac97f13_20250603T14:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. This is [PII]. I've got Miss [PII] on the phone um she is with NAS she's the broker, um.
[CUSTOMER][NEUTRAL] She's on our hot list, so she's one of the ones we treat special. She's calling about um claim number 3606059 on policy number 257-0930 and she received an email today but I'm showing the claim was paid but she received an email today that she's wanting to talk about the claim.
[AGENT][NEUTRAL] Um, did she say what the email was about?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] 6159 OK.
[CUSTOMER][NEUTRAL] She just immediately when I talked to her, she said, I need cancer claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And everything's been verified for her [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, it has.
[AGENT][NEUTRAL] And and it's for [PII], right?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thanks [PII] bye bye.
[AGENT][POSITIVE] You're welcome [PII] go ahead and transfer me thank you.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Hi, how are you?
[AGENT][POSITIVE] I'm doing well thank you this is [PII] on the claim support team.
[AGENT][NEUTRAL] Uh, [PII] said you needed to speak to someone in [PII], mhm.
[CUSTOMER][NEUTRAL] Hi, what did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Hi [PII], I think we spoke before. This is [PII] from NAS.
[CUSTOMER][NEUTRAL] Um, I'm calling about this [PII] cancer claim.
[CUSTOMER][NEUTRAL] We just got an email from your care team saying that it doesn't qualify for the lump sum.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, first, hold on, let me look at it again.
[AGENT][NEUTRAL] For the the first the current benefits.
[CUSTOMER][NEGATIVE] Does not qualify.
[CUSTOMER][NEUTRAL] Incision or OK. According to the pathology report, diagnosis was confined to the tissue in which it developed with no evidence of uncontrolled growth or spread of cells to other parties. Under the policy definitions, the lump sum benefit is only payable under. OK, so can you explain that to me a little better?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] So, so the finding of cancer itself is not payable?
[AGENT][NEUTRAL] Um, let me.
[AGENT][NEUTRAL] Pull up, I'm looking for that and she said it was 3606059 was the claim number, correct?
[CUSTOMER][NEUTRAL] Try we discuss.
[AGENT][NEUTRAL] Or is it a different
[CUSTOMER][NEUTRAL] That's what they gave me when they.
[CUSTOMER][NEUTRAL] That's what they gave me with the payout anagram, the 480.
[CUSTOMER][NEUTRAL] Something. Hold on.
[CUSTOMER][NEUTRAL] Um, for
[CUSTOMER][NEUTRAL] 48075.
[CUSTOMER][NEUTRAL] That was paid.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's the reason we um emailed back because the broker is up in arms because.
[CUSTOMER][NEUTRAL] She only got 480 and not the 1000.
[AGENT][NEUTRAL] Yeah, well.
[CUSTOMER][NEUTRAL] So I need to understand it to explain it to him.
[AGENT][NEUTRAL] Understood, yes, OK, so it looks like that um from what I'm following here that the.
[AGENT][NEUTRAL] The diagnosis itself did not fall under the cover diagnosis for a lump sum. So let me try to um
[CUSTOMER][NEUTRAL] I'm trying to figure out, does she have cancer or did they just do a biopsy?
[CUSTOMER][NEUTRAL] I'm reading, I'm reading the mammography report right now. Of course, I'm not a doctor, so the risk benefits, blah blah blah with the patient sitting upright blah blah blah, local lidocaine, the blah blah, savvy. OK, so this is a mammography. A post-procedure mammogram of the breast demonstrates the deployed satty radar reflector.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And expected surrounding post, the residual cons is explaining to the patient tolerated the procedure.
[CUSTOMER][NEUTRAL] Status post vacuum assisted er needle of right breast calcifications with savvy radar replacement as described an adendum will be issued when histology results become available. OK.
[CUSTOMER][NEUTRAL] Do you happen to know what histology is?
[AGENT][NEUTRAL] That um.
[CUSTOMER][NEUTRAL] Final report.
[AGENT][NEUTRAL] Yeah, that, it's just a little bit, um, I'm, I'm not sure exactly what that
[AGENT][NEUTRAL] Ah,
[AGENT][NEUTRAL] Definition what that definition, but
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, so I do see here high grade ductal carcinoma incido of commodo, whatever that is, solid and
[CUSTOMER][NEUTRAL] Cribriform types with central necrosis and calcifications.
[CUSTOMER][NEGATIVE] Malignant and concordant with imaging findings.
[CUSTOMER][NEUTRAL] So I wonder if they read that. Let's see.
[AGENT][NEUTRAL] I'm in the process of looking for the notes from uh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But there's a lot of mail. I have to go through each one of them and my apologies for that, um, cause they were the documents we received, there was um.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Quite a few actually, yeah.
[CUSTOMER][NEUTRAL] Well there was tons. I had to, yeah, I, I had to upload it separately because the system, yeah, the system wasn't allowing me to do it as a lump sum.
[AGENT][NEUTRAL] So you know,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Findings and recommendations were discussed. Patient will be contacted by breast cancer coach. OK, so high grade ductal.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] High grade.
[AGENT][NEUTRAL] And what I from what I'm seeing is it's not coded as uh.
[AGENT][POSITIVE] This might be something that I need to have a little bit more time to research, [PII], and I would actually like to um review it with um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Probably someone on our cancer team, um, because I wanna make sure that we're, uh,
[AGENT][NEUTRAL] Providing you with the.
[CUSTOMER][NEUTRAL] Oh, I thought
[AGENT][NEUTRAL] Necessary.
[CUSTOMER][NEUTRAL] I thought you were with the cancer team because you are?
[AGENT][NEUTRAL] I'm, I'm on the claims support, um, however, because this is a little bit more like I said complex and um I would prefer to reach out to somebody that has a little bit one of my colleagues that has a little bit more experience with it, um, more specifically, um, this.
[CUSTOMER][NEUTRAL] OK. Can I give you my number?
[AGENT][NEUTRAL] Yeah and that's what I was just gonna say it probably would be best if I could just um either I'll reach back out to you or I'll have one of um my colleagues reach out and just explain it a little bit better so that you can um understand and also so that you can you know be provided with the information as well.
[AGENT][NEUTRAL] So what is your best contact?
[CUSTOMER][NEUTRAL] OK. Can you
[CUSTOMER][NEUTRAL] Can you please make sure that you tell them it's urgent because this is, this is our highest um selling broker. OK, my number is [PII]. My name is [PII]. I'm only here till [PII] because I myself have to go to Moffet, which is a cancer institute, um for a follow up. So if
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] I if you, if somebody calls me, please leave me a message.
[CUSTOMER][NEUTRAL] And uh if I don't get it, but I will take, I will have my phone on so I can take it, get it on the road there and while I'm waiting.
[AGENT][NEUTRAL] OK, and you said you did, did you re you said you did receive this letter that they sent to uh out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, um, the care team responded to us this morning.
[AGENT][NEUTRAL] Or is it just the EOB? OK.
[CUSTOMER][NEUTRAL] No, the care team responded to us this morning in an email.
[AGENT][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] Would you like me to send you that?
[AGENT][NEUTRAL] No, I have it. I'm looking at it now I'm looking at it now.
[CUSTOMER][NEUTRAL] Would you like me to send you that?
[CUSTOMER][NEUTRAL] The the one dated [PII] at [PII].
[AGENT][NEUTRAL] Just let me, it's I'm I'm waiting for it to load just uh my apologies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah it looks like this one was addressed to [PII] and did you receive this one as well?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah, because I'm, I'm the agent concierge team member that handles claims, so I was out of the office yesterday and it went to [PII] in my absence.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so we're we're just looking like I said for that confirmation that or why that uh first occurrence benefit because according to what they're saying is that the internal uh it doesn't it falls outside of the coverage parameters for the internal cancer first occurrence benefit.
[CUSTOMER][NEUTRAL] OK hold on.
[AGENT][NEUTRAL] And that's according to that what was in that pathology report from [PII].
[CUSTOMER][NEUTRAL] Yeah, so, so
[CUSTOMER][NEUTRAL] Yeah, so we just need to know if it's just a coding problem or if based on the report and the final report, that is still APL determination.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] It does.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for taking my call.
[AGENT][NEUTRAL] OK, and it's, it's [PII]. I'm sorry, [PII], and I will call you back shortly or like I said, that's OK. I know you talked to [PII] first.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. I was, I was recording. Sorry.
[AGENT][POSITIVE] That's OK, understood. I know you're busy too, so, um, yes, I'll be, uh, I'll I'll be in contact with you soon.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.