AccountId: 011433970860
ContactId: 32b55b8a-21b6-468c-af23-a7fba6749dcb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 649260 ms
Total Talk Time (AGENT): 308432 ms
Total Talk Time (CUSTOMER): 253297 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/32b55b8a-21b6-468c-af23-a7fba6749dcb_20250417T20:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you?
[AGENT][POSITIVE] Doing well [PII] thank you how are you?
[CUSTOMER][POSITIVE] I'm doing good. Um, I have an insured on the other line. They
[CUSTOMER][NEUTRAL] So she had pancreatic cancer. Now she's getting um
[CUSTOMER][NEUTRAL] Like treatments because of the damage it did. And we're asking for a pathology report. I have the policy number. It's 644.
[CUSTOMER][NEUTRAL] 574.
[AGENT][NEUTRAL] OK, let me pull that up.
[CUSTOMER][NEUTRAL] And we're ask mhm we're asking for a pathology report, but she's like, well, I, I haven't had one recently. This is just
[CUSTOMER][NEGATIVE] Um, she said she's brutal and things, so she goes into the ICU every now and then because of the cancer, but she doesn't have like, I guess an updated pathology report. I didn't know how to, she's asking what to do.
[CUSTOMER][NEUTRAL] I don't really know.
[AGENT][NEUTRAL] So did she send in the previous one or we don't know.
[AGENT][NEUTRAL] Because it says it's for the day's [PII].
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] You don't see one?
[AGENT][NEUTRAL] Or you don't know.
[CUSTOMER][NEUTRAL] I don't see a pathology report in there.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I looked on OnBase. I mean, there's quite a few um
[CUSTOMER][NEUTRAL] I guess like lines. So I went through all of them, but I don't see, I see itemized bills in the claim form. I didn't see a pathology report and that's what we're asking for, but she doesn't, she doesn't know if she can use the previous one. I didn't tell her she could. I didn't know how to answer the question.
[AGENT][NEUTRAL] Well if that's all she has then yeah she would need to send that in but um I will.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, speak with her. I'm gonna pull up some of this mail and it it's, and it's, uh, regarding the, yeah, I see that mhm.
[CUSTOMER][NEUTRAL] It's a lot too.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And she's been verified, [PII]?
[CUSTOMER][NEUTRAL] Yes, fully verified.
[AGENT][NEUTRAL] And that's her phone number listed [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And [PII] sides, right?
[CUSTOMER][POSITIVE] Mhm. That's correct.
[AGENT][POSITIVE] Alrighty you can go ahead and transfer when you're ready.
[CUSTOMER][NEUTRAL] Alright, thank you, [PII]. Hold on one moment.
[AGENT][POSITIVE] Sure, you're welcome, ma'am.
[CUSTOMER][NEUTRAL] Hello Ms. Is.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Hey, thank you so much for holding.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes ma'am, hello.
[AGENT][NEUTRAL] Hi, I'm here. Oh, hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, Miss. My name.
[CUSTOMER][NEUTRAL] Sorry, [PII], my phone just went completely out. I apologize.
[AGENT][POSITIVE] That's OK, go ahead and transfer. thank you.
[AGENT][NEUTRAL] Besides
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Can you hear me OK?
[CUSTOMER][POSITIVE] Yes ma'am, I can.
[AGENT][NEUTRAL] OK, my name's [PII] and I'm on the claim support team and and I transferred you over to me um you had some questions about some information we're requesting for your claim, is that right?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so it looks like we're needing um some uh pathology report and [PII] um had stated that you don't have a current pathology report, is that right?
[CUSTOMER][NEUTRAL] That is correct. So I was telling her, I um
[CUSTOMER][NEUTRAL] Of course, I have pretty frequent visits, but I, in [PII], I, I had my complete pancreas removed um at MD Anderson Cancer Center for pancreatic cancer.
[AGENT][NEUTRAL] Uh huh.
[CUSTOMER][NEGATIVE] Which has left me.
[CUSTOMER][NEUTRAL] With a lot of health problems. Um, and so I have to go in fairly often, of course, I don't get
[CUSTOMER][POSITIVE] My pancreas is not there anymore. They have completely removed it. So I don't have pathology done, you know, obviously every time I go.
[CUSTOMER][NEUTRAL] Um, or every time I'm in the hospital or anything like that, um, so I was just kind of questioning, you know, uh, of course they're not gonna always do biopsies and pathology on an organ that's not there anymore, um, we do constant scans, you know, to make sure that we're not nothing else is in any other spots and different things like that and watching things, but as far as pathology, I'm not gonna have those every time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. Understood.
[CUSTOMER][NEUTRAL] So, does that make sense?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But my hair is going to be ongoing, you know, it's going to be ongoing and of course this is not a file against like the big, the big cancer policy, but.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Right now because this was in [PII], do you have uh the services, so in [PII], do you have a pathology report from then or no?
[CUSTOMER][NEUTRAL] You, you guys, I've already filed that one. We, um, that was filed back a couple of years, maybe in [PII]. I sent that in maybe, um, from that original pathology and all of that was sent in at that point but yes it is on my chart still I can you know get you a new copy of that if I need to.
[CUSTOMER][NEUTRAL] Um, but you guys have already paid out for the day that was like [PII], [PII], you know, our second week of January, I was in the hospital there and that pathology would have been with that filing.
[AGENT][NEUTRAL] OK, now.
[AGENT][NEUTRAL] Give me one moment, let me see if I can locate that, um.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Now there is a quite a bit of mail here so if you'll bear with me while I look through this trying to locate it because it looks like that's what they're asking for is that pathology so it doesn't necessarily need to be something uh a current pathology report obviously if you don't have it organ they wouldn't do a pathology on that on that, um, so I, I believe that.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It would be the path that they I would assume that they're meaning you know that because that date is [PII] that that's what they're looking for as far as um you know that request so I'm looking though to see if I can locate it now um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And you
[CUSTOMER][NEUTRAL] And I'm trying to pull it up on my my chart right now so I can give you a more accurate date.
[AGENT][NEUTRAL] And that's why I was just gonna ask, so you said it was in [PII], right?
[CUSTOMER][NEUTRAL] Go ahead, I'm
[AGENT][NEUTRAL] Did you send it in?
[CUSTOMER][NEUTRAL] Um, that I filed that one, I believe it would have been the last ones that I filed prior to this, but I feel like that's it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's what I'm gonna try to, so like I said, I'm attempting I have to go through each um each claim that was filed that packet of, you know, documents so like I said it takes a little bit of time to pull them up and the computer has to cooperate of course.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I think I see it here so.
[AGENT][NEUTRAL] OK, and that would have been from [PII], is that right?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Does that sound right? OK, so I do have that pathology report. So what I, what I can do now, um, let me just see if there was any other information that we were requesting.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Because I do see there were some services that were um denied as um duplicate. Then we had some non-covered services as well, but it looks like the services for [PII] that we were um requesting that information for was some hospitalization and then surgery and anesthesia for uh [PII] and then [PII], it looks like. OK. So, um.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] If you'll um.
[AGENT][NEUTRAL] If you will, uh, what, what I can do is I'm going to try to um attempt to reach out to the adjuster that's processing this information and let them know that we do have that pathology report and where to find it and I'm gonna ask her to if she can review it and see if this is the information she's needing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and if there's anything else that I can, uh, you know, get, you know, from her as far as what else is needed, but it looks like to me that that's all they're requesting, so if we already have that, um, I'm gonna attempt to, like I said, have her review it and see if we can go ahead and process your claim or if there's anything else that's needed um would it be OK if I gave you a call back?
[CUSTOMER][POSITIVE] Yes, ma'am, that would be wonderful.
[AGENT][NEUTRAL] And that number to reach you at [PII] is a good number?
[CUSTOMER][NEUTRAL] Yes ma'am, now I will, and I don't know if it will be today, but if it is, I will be in Bible study starting around [PII], but you could always leave me a voicemail if you needed to or whatever you, whatever is easier for you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's OK to leave a voicemail?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes ma'am, that'll be fine.
[AGENT][POSITIVE] I hope to um reach her uh because I know that she leaves she's got a little bit earlier schedule so if she um hopefully she can go ahead and review it for me quickly and I can get an answer for you before before that happens so that I can connect with you. So, um, but if need be I'll leave you a voicemail uh and again my name is [PII] and I'm in the claim support team so let me reach out to her and I'll get back with you shortly.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, Ms. Do you have any other questions?
[CUSTOMER][POSITIVE] Thank you very much. You have a nice afternoon. All right.
[AGENT][POSITIVE] Do you have, do you have any other questions at this time? OK, I'll get back with you shortly. Thank you so, OK, thank you so much for your patience. All right, take care. Bye.
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[CUSTOMER][POSITIVE] No, ma'am, that's gonna be all. I appreciate it thank you.
[CUSTOMER][POSITIVE] Alright bye bye. Yes ma'am, yes ma'am bye bye.
[CUSTOMER][NEUTRAL] You