AccountId: 011433970860
ContactId: 387a574c-bf0a-4776-8066-782385795e93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1167189 ms
Total Talk Time (AGENT): 235831 ms
Total Talk Time (CUSTOMER): 462048 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/387a574c-bf0a-4776-8066-782385795e93_20250603T13:38_UTC.wav
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[AGENT][NEUTRAL] more
[CUSTOMER][NEUTRAL] What does it say?
[AGENT][NEUTRAL] [PII] speaking may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, my name is [PII]. I'm an oncology clinic social worker and I have you on speaker phone and I have our patient [PII] and his wife, and we had some questions about what was it that you had specifically. There's some documentation that was submitted that wasn't accepted on your end, and that's what we're trying to figure out what, what specifically you want and what format and also the second question would be.
[CUSTOMER][NEUTRAL] There's a decision that was made and she has 180 days they have 180 days to appeal it which is this like basically a few days so we wanted to know where to fax that and um what specifically you needed contained in that document as well.
[AGENT][NEUTRAL] OK, uh, I can verify that for you, Ms. [PII]. What's that policy number, please?
[CUSTOMER][NEUTRAL] I, I think our policy number is 02403166.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Your what's your number? [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah this is he.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It looks like we need the initial pathology report, first diagnosing Mr. [PII] of cancer.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I would I would think, but I went ahead and somebody told me just to.
[CUSTOMER][NEUTRAL] initial pathology report for for what? because you, you guys, I'm, I'm, I'm just kind of interceding in this um if you wanna just sit there what.
[CUSTOMER][NEGATIVE] Which, which, which he's he's he's still battling cancer. He's having another.
[CUSTOMER][NEUTRAL] So, so I'm talking to you about the second cancer he had, which is the first cancer that was covered covered under our policy, um, the last paperwork we sent y'all on page 5 I believe it is, would you look at that page because I believe that has the paperwork that you need.
[AGENT][NEUTRAL] Uh, when was that sent?
[CUSTOMER][NEUTRAL] And for what chance
[CUSTOMER][NEUTRAL] What was that ma'am?
[AGENT][NEUTRAL] When was it sent?
[CUSTOMER][NEUTRAL] Where or when?
[AGENT][NEUTRAL] When was it sent?
[CUSTOMER][NEUTRAL] With um.
[CUSTOMER][NEUTRAL] In the [PII].
[CUSTOMER][NEUTRAL] Uh, let me look back and see if I've got a date, anything that's dated.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, uh, on [PII] y'all sent me something saying that you have received my information and my claim has started, so I'm gonna guess that it was before that.
[CUSTOMER][NEUTRAL] It says you'll contact me if you need more information.
[AGENT][NEUTRAL] Well, the, uh, the last claim that was received before that one, that's the one where they paid for.
[AGENT][NEUTRAL] Preventative, but they are requesting the.
[AGENT][NEUTRAL] Initial pathology report.
[AGENT][NEUTRAL] Looks like data service [PII].
[CUSTOMER][NEUTRAL] Yes, and so.
[CUSTOMER][NEUTRAL] What was [PII]?
[AGENT][NEUTRAL] Uh, that's the date I'm showing there. I'm requesting the first, uh, or initial pathology report.
[CUSTOMER][NEUTRAL] Um, OK, did y'all receive paperwork, the paperwork you received right before that?
[CUSTOMER][NEUTRAL] Do you see that?
[CUSTOMER][NEUTRAL] It was, it was quite a few pages, maybe, maybe like 16 or 25.
[AGENT][NEUTRAL] Give me one moment please.
[AGENT][NEUTRAL] Give me one moment I'm pulling up that uh claim information OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So as soon as I sent the paperwork before that.
[CUSTOMER][NEUTRAL] But this dated [PII].
[CUSTOMER][NEUTRAL] Since we've received your claim.
[CUSTOMER][NEUTRAL] So that makes me feel like I don't know maybe it could have even been today.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well, I know you have stuff written on the back of this page right here. That was turned back quite a while back, I think.
[AGENT][NEUTRAL] And you said it's possibly on page 5.
[CUSTOMER][NEUTRAL] Yes ma'am, could you tell me what's the heading of page 5, like what's that document entitled?
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] Uh, it's just those progress notes.
[CUSTOMER][NEUTRAL] OK, that's not the one that says uh pathology consultation services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh I see information from urgent care.
[CUSTOMER][NEUTRAL] Is the document you're like the, the package that we sent you of all those different, there's like a lot of different bills, I mean, um, statements and stuff in there is it like a long, is it like 16 or 25 pages long?
[AGENT][NEUTRAL] Uh, yes, cause total pages came through is showing 30.
[AGENT][NEUTRAL] This is just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like.
[AGENT][NEUTRAL] Imaging notes.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, this will look like urgent care notes. Uh, give me one moment, just look at another.
[AGENT][NEUTRAL] One
[AGENT][POSITIVE] And I apologize it's taking a while to pull up.
[CUSTOMER][NEUTRAL] OK, I, I just, I'm gonna go over and get a reprint out today if, if I have not turned in what I need but I need to know the exact name.
[CUSTOMER][NEUTRAL] Of what what it is that you're wanting.
[CUSTOMER][NEUTRAL] Um, he, I think it was [PII] was the first. Nobody, none of us had any idea that he had another cancer, and I think it was on [PII], wait a minute, what? [PII], yeah, [PII] on on [PII].
[CUSTOMER][NEUTRAL] Is when
[CUSTOMER][NEUTRAL] Let me think about that a minute. Was it [PII] or [PII]?
[AGENT][NEUTRAL] I see on 23 days uh for imaging on [PII].
[CUSTOMER][NEUTRAL] Well, I don't know because you're.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, and that was where they first discovered the kidney cancer. Nobody knew that existed before that. The cancer he had had before was prostate, and then that one turned then they, they did that image and saw that he had, that was the beginning of us finding out that he had kidney cancer and then they went on and had to remove his kidney and all that.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. So they didn't do a biopsy. They actually just uh imaged, um, didn't.
[CUSTOMER][NEUTRAL] So what for that.
[AGENT][NEGATIVE] An image and it showed that it was cancerous.
[CUSTOMER][NEUTRAL] I know that that was how we count.
[AGENT][NEUTRAL] So it wasn't necessarily, they didn't do a biopsy?
[CUSTOMER][NEUTRAL] You know, I don't remember if they did a biopsy. I just remember that was the initial day of how we found out and then I mean and then and then later they did surgery and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can't remember if they did it at [PII], uh, yes, yeah, because I, because we're part of the problem is I'm, he's at a facility now where I could normally look that up, but it was at our sys a different facility in.
[CUSTOMER][NEUTRAL] Uh, the same town, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I can't look that up. I tried to help her in that way, so we're what we're trying to do is figure out what is still lacking based on all of that so she can go back to them and request it and send that specific piece of information to you. I, I've tried on my end to see because we we can share like the medical record system but not going in that deep.
[CUSTOMER][NEUTRAL] If that makes sense, I mean there's some things that transfer over but not that specific stuff so any kind of pathology reports, biopsy, any of that type of thing, um, I'm not gonna have access to.
[CUSTOMER][NEUTRAL] Um, I can't, I can't remember if they did a biopsy before the surgery, but at some point they did test it because they told us that it was, it was kidney cancer, a renal renal cell, yeah.
[AGENT][NEUTRAL] So [PII], I'm like, yeah.
[CUSTOMER][NEUTRAL] Yeah, so they would have had to biopsy it. It's just that I don't have access to that, but if you, if there's a way that you can look to see in her documentation what is still lacking, then she can specifically ask for that because it would probably be what I'm guessing is is you guys need a pathology report or something?
[AGENT][NEUTRAL] Yes, ma'am. Uh, with the cancer policy, uh, they always need the initial pathology report first diagnosing them of cancer.
[CUSTOMER][NEUTRAL] Sure, so with the pathology consultation services, is that not a pathology report?
[CUSTOMER][NEGATIVE] It tells the surgical pathology final result and it's uh it's all it's mostly in medical language so I don't understand this isn't the the right one. I've got a bunch of these, but that's that's not really the right one.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Does it show the date of service for that um pathology report?
[CUSTOMER][NEUTRAL] On, on the tho the what you have, I'm pretty sure I thought there was the that the pathology consultation services for this particular cancer we're talking about. I thought it was in that packet I sent you.
[CUSTOMER][NEUTRAL] And if it is it at the top of the paper, um, it has their letterhead which is or whatever you call it, it says [PII]'s Health on one side the top left and then on the top right it has like the title of the page and it says pathology consultation services.
[CUSTOMER][NEUTRAL] And the one I'm looking at is for the wrong date. It's not the date that you need. I mean, I have, I'm looking at a pathology service that's dated um.
[CUSTOMER][NEUTRAL] [PII]. 0 wait, does that say? Yeah, this has got the kidney one. This is [PII] and it and it's do uh synoptic reporting and invasive carcinoma of renal tubular origin and then she doesn't have this 10, you don't have this one. She does not. OK, well, does she need it? Is that what is it with this one to?
[AGENT][NEUTRAL] Um, but I'm not sure. Uh, let me transfer you to an examiner and they can get down to specifics, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] I was just trying to see if I can help by looking through here, but hold on one moment for me, OK? All right, thank you so much.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Blessed all the bliss.
[AGENT][NEGATIVE] Too much
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you doing today?
[CUSTOMER][NEUTRAL] I'm fine thanks how are you?
[AGENT][MIXED] I am fine and [PII]. Um, I have an insured with his wife, or insured and her husband who was diagnosed with cancer and they're at a
[AGENT][NEUTRAL] I guess a medical facility. They want to know exactly what we would need in order to process his claim for his uh cancer diagnosis.
[AGENT][NEUTRAL] And I'm trying to look through all the information they sent because one has over 600 pages, another has 30, and one has 13.
[AGENT][NEUTRAL] And I cannot find.
[AGENT][NEUTRAL] The pathology report that she is saying because it looks like we uh process is needed the initial path report.
[AGENT][NEUTRAL] But it looks like they also had a scan done. She said that is how they found that he had kidney cancer.
[AGENT][NEUTRAL] And then they had the kidney removed.
[AGENT][NEUTRAL] Anyway, um, the policy number is 2403166.
[CUSTOMER][NEUTRAL] OK, so is she saying that they did not have a biopsy, pathology report?
[AGENT][NEUTRAL] Right, that there was no biopsy that they did a scan and that detect the cancer and then they had the kidney removed.
[AGENT][NEUTRAL] And I'm trying to look and see, but I can't see anything.
[AGENT][NEUTRAL] I can see some stuff, but it's just a lot.
[CUSTOMER][NEUTRAL] OK, so you just want me to tell them what we need to file their for their claim?
[AGENT][NEUTRAL] Yeah, she wants to know exactly what information we need.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and I'll help them um what's the callback number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're gonna hear a lot of voices. It's the insured, uh, her husband and the.
[AGENT][NEUTRAL] I guess the lady at the hospital that is trying to help them.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Awesome thank you ma'am have a great one.
[CUSTOMER][NEUTRAL] You too.