AccountId: 011433970860
ContactId: 407ac418-59dc-4abd-91c8-6d1b441480f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1169060 ms
Total Talk Time (AGENT): 463210 ms
Total Talk Time (CUSTOMER): 623124 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/407ac418-59dc-4abd-91c8-6d1b441480f2_20250409T22:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], and I have uh a question on a claim that we turned in on my husband's policy.
[AGENT][POSITIVE] OK, I could definitely take a look at that claim for you, [PII]. Can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] All
[CUSTOMER][NEUTRAL] Yes, ma'am. This is the only one. It's a landline, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I have the uh.
[CUSTOMER][NEUTRAL] Benefit claim and I think it's the same 98.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 9A20631
[CUSTOMER][NEUTRAL] And there's a reference.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You want the reference number?
[AGENT][NEUTRAL] Uh, sure, I'll go ahead and take that.
[CUSTOMER][NEUTRAL] 00110443 and then there's a claim number.
[CUSTOMER][NEUTRAL] 356.
[CUSTOMER][NEUTRAL] 1762
[CUSTOMER][NEUTRAL] Robert
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alley.
[AGENT][POSITIVE] All right, I sure appreciate all of that information. OK, give me just a minute let me get all of this pulled up.
[CUSTOMER][NEUTRAL] OK, give me just
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Now is [PII] uh present that I could speak with him verify his information?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] he is
[CUSTOMER][NEUTRAL] Outside at the moment.
[CUSTOMER][NEUTRAL] Do it, it'll be about 5 minutes before he's back in.
[AGENT][NEUTRAL] That is perfectly fine unfortunately as um he is the only one listed under this policy, I do have to speak with him verify his information and of course make sure it's all right to speak with you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I understand. He told them it was OK when I called in once before, but I guess we have to do it every time.
[AGENT][NEUTRAL] Yes, that's right, those are only good for the one single phone call. uh, now I will say there is a form, um, do y'all have access to a desktop or a laptop computer, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, there is a form on our website that is an authorization form, uh, that he could fill out with your information and give that to us. He could email it to us or whatever is easier for y'all and then we wouldn't have to, you know, bother him every time and we could speak with you about everything regarding the policy.
[CUSTOMER][NEUTRAL] It, it's usually not a problem. He's usually in here with me, but uh it's having he's outside right now. Um,
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I'm looking to see. I don't know what email we have used.
[CUSTOMER][NEUTRAL] On American life before, I don't think I have.
[CUSTOMER][NEUTRAL] You don't show an email on his.
[CUSTOMER][NEUTRAL] Uh, information.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] I do have one. You know what, Ms. [PII], I think I've spoken with you before because I recognize this email address. Um, I'm in [PII] too and I'm also a Sooner fan. I'm in [PII].
[CUSTOMER][NEUTRAL] And I.
[CUSTOMER][NEUTRAL] Yes, I remember you. I
[AGENT][NEUTRAL] I think, yeah.
[AGENT][NEUTRAL] I was gonna say that was a while ago too, but I recognized that email.
[CUSTOMER][NEUTRAL] Are you [PII]?
[AGENT][NEUTRAL] No ma'am, I'm [PII].
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Good guesses though 10 they're both.
[CUSTOMER][NEUTRAL] Cause I know I wrote it.
[AGENT][NEUTRAL] Yeah, [PII] is also in [PII], yeah.
[CUSTOMER][NEUTRAL] I know I wrote
[CUSTOMER][NEUTRAL] Yeah, OK. Um, OK, [PII], what, uh, uh, but he, he'll be back in in just a second, but, um.
[CUSTOMER][NEUTRAL] Do you show an email sooner than is that our email?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. That's the one we usually use for his stuff. So,
[AGENT][NEUTRAL] OK, if you want I can send you, um, I can go ahead and email you, uh, this third party authorization form, but it's completely up to you.
[CUSTOMER][POSITIVE] That would be awesome. I wouldn't have to try to get your size.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, give me just a moment, let me go ahead and get that sent right now.
[AGENT][POSITIVE] I don't blame him for being outside. It is gorgeous today.
[CUSTOMER][NEUTRAL] Will we get
[CUSTOMER][POSITIVE] Well, it is really pretty here too. Uh, it's been, you know, we've had a lot of snow. We're in [PII] right now and uh we've had a lot of snow.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Y'all aren't in [PII] at the moment? Oh, Wyoming, I bet that's gorgeous.
[CUSTOMER][NEUTRAL] But it's really
[CUSTOMER][POSITIVE] It is, it really is, but I'm glad, uh, Oklahoma's doing all right. I talked to my daughter and, uh,
[CUSTOMER][NEUTRAL] You know, they live in [PII] which is where all the the fires were a couple of weeks ago.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][POSITIVE] She said it's been raining and she's happy for the rain.
[AGENT][POSITIVE] Absolutely, yeah. Nice break from the normal spring weather we get.
[CUSTOMER][POSITIVE] Right. Now, [PII], will we get you back at when we send this form in? cause I loved it, you helped us before.
[AGENT][NEUTRAL] Oh, I can't guarantee it. um, it just really depends, but I mean, you know, anybody on our team is real nice, I promise, but you can always ask for me too.
[CUSTOMER][NEUTRAL] OK, because all that we have, we've got the check, but the main benefits weren't covered and uh it uh and I guess I'm not supposed to talk to you about it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, no, no, that is perfectly fine. Give me just a moment.
[CUSTOMER][NEUTRAL] It's asking for a pathology report that one of the
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The he has it in his.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He, he puts it in his
[CUSTOMER][NEUTRAL] I don't, his statement, his information that he said when we asked him to mail all of that to you and on the uh form it says pathology report, but it's just documented right in the.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, so I, I, I need to know.
[CUSTOMER][NEUTRAL] Uh, I thought [PII] would be back in here. Uh.
[AGENT][NEUTRAL] No, no, you are perfectly fine. Um, that's definitely information I can go ahead and give you're asking those specific questions that is perfectly fine. Um, OK, so just so that I understand correctly, with all of this claim information y'all did send that pathology report.
[CUSTOMER][NEUTRAL] Well, on the, um,
[CUSTOMER][NEUTRAL] On the form.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That, that was attached to the um
[CUSTOMER][NEUTRAL] It says pathology pours.
[CUSTOMER][NEUTRAL] And I, I wondered why that wasn't accepted.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it does look like it's in regard to the surgeries.
[AGENT][NEUTRAL] So do you know if that's what you sent? OK.
[CUSTOMER][POSITIVE] Correct. There.
[AGENT][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so there are no benefits for just a regular biopsy.
[AGENT][NEUTRAL] Um, consideration has to was the.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] No, that's OK. Uh, 2 of them.
[CUSTOMER][NEUTRAL] Uh there's a
[CUSTOMER][NEUTRAL] There's [PII], which is that you need the pathology report.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. OK. Uh.
[AGENT][NEUTRAL] OK. So, let me ask you this, um, and I know this is gonna sound like a silly question, but was he positively diagnosed with cancer?
[CUSTOMER][POSITIVE] Yes, absolutely.
[AGENT][NEUTRAL] He was? OK. So that's where there can be a bit of confusion with that. So I just wanted to clarify, um, any sort of procedures including like surgeries or biopsies, if they result in, you know, not finding cancer or anything like that, that would not be covered under this policy.
[AGENT][NEUTRAL] Only surgeries and or biopsies that did result in that. So I think that's the, when they say that they need that pathology report, they want to see if those specific surgeries found cancer. Like if those were the surgeries that found the cancer. Does that make sense?
[CUSTOMER][NEUTRAL] OK. The surgery, this is a Mos doctor.
[CUSTOMER][NEUTRAL] And he does, the cancer had already been diagnosed by a biopsy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But then he did the surgery on the cancer.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] It was definitely
[AGENT][NEUTRAL] OK, OK, so what I think we need to do, [PII] is just kind of review the information that was submitted to us um and that way we can pinpoint what if any because you know of course we are human it's definitely possible that we made an oversight and um so we could it could be fine but um that way we can determine what if any uh information additional information we do need more specifically so.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, unfortunately for that I will have to have [PII]'s consent, so, um, but I did send you an email with that authorization form so whichever comes first, and I don't mind hanging on the phone with you for a little bit, that's perfectly fine, but if you prefer to give us a call back, um, we're open for another half hour, so that's completely up to you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] If I could find that on this, it said pathology report and um
[CUSTOMER][NEUTRAL] Oh, OK. There were 2 doctors and one, I've got the one, claim form which was Doctor [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And she did not include that. It's Doctor uh.
[CUSTOMER][NEUTRAL] [PII] and on the pathology report, it gives a pathology uh full thickness, something, something is present in the epidermis. Deeper tumor islands of dyeric something are present. squamous ED formation is present.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Diagnosisho cell carcinoma invasive.
[CUSTOMER][NEUTRAL] So that report was included with each of his claim forms. What I was wondering, what else do you need to qualify as a pathology report for me to call that doctor and get it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Absolutely. And that's what I want to take a deeper look at, [PII], just, uh, to see these individual cause I see multiple items submitted. Some do say uh from Dr. [PII] like you said, but there are also some that simply say from Tulsa Dermatology Clinic. Um, and so I think that might be where there's a bit of confusion. So it might look like there's more than one physician or indoor provider. So there, that's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][POSITIVE] That is correct. Yes, that is correct. Tulsa dermatology.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and, and your, uh, check with the receipt is what I'm going by. And what they did put each transaction in date order. So you'll have a dermatology and they had uh an actual surgery, but she doesn't include a pathology report like the second.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] A which was [PII] and the more.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Surgery with [PII] because he, he's a Mos doctor and what he does, he takes the first
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A surgery and then he can test it in his office.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then he goes back. If the office, if that test shows there's more cancer, he keeps the patient there in the chair until his pathology report comes back clear that he's gotten every bit of
[AGENT][NEUTRAL] I see. OK.
[CUSTOMER][NEUTRAL] So that's his pathology report. I, I think he will tell me I don't do any deeper, you know, my report is what I did.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, OK, so the next step, yes, and so if that and again that could very well be sufficient if we explain that to um our claims specialist, the one who you know actually go through and file that information they process that information um so that's what you know I'm I can't hand you over unfortunately until uh we can get [PII] on the line so I I think we'll be able to work with this so.
[CUSTOMER][NEUTRAL] But we need to know.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. All right. That was mainly, uh, you know, if, if you just say no, they, they don't cover that because this is what we understood that the insurance is supposed to do the, the smaller uh services that aren't covered, uh, are just burn the pre-cancerous and cancerous cells, but we understood it was cover surgery.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right and that's again that's yes and so I do see of course like you said, the smaller items that they don't pay a benefit for um but yeah regarding these surgeries uh what I think you know we just kinda need to bring it to their attention again number one check for human error, um, make sure it wasn't something that they might have overlooked um and then of course if there was something additional they'll be able to point you in that right direction and exactly what it is that they're needing to get that processed.
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And I was hoping he'd be here by now, but he's not. So, um, I'll get that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] And uh cause it sounds like we, he does need to talk to you so we can verify and.
[AGENT][POSITIVE] Yes, and then of course whichever comes first, you know, if you wanna um if for some reason it's after we've already closed today, uh, which we've got about another 25 minutes, um, you know, he can always fill out that form that I emailed and then you know you can just give us a call tomorrow, um, or he can whichever is easier for y'all.
[CUSTOMER][NEUTRAL] See what we need
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. All right. We'll do that and I hope we get cause I, I had your name written down and I thought, oh I hope I get her this time cause we had such a good time. Are you watching the girls so?
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] Are you watching the girls?
[AGENT][NEGATIVE] At the moment, I have not been able to. My son has been so sick and has been taking all of my attention.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] What
[AGENT][POSITIVE] He is [PII] old, so he's got, you know, he catches everything.
[CUSTOMER][NEUTRAL] Has he had
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Right. There's been several up here that have had real, real serious viruses, but, uh,
[AGENT][POSITIVE] Yeah, there's all kinds of stuff going around and, you know, once we kick something, of course, you know, he goes to school, so he's gonna get everything.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh, the young couple that read our pasture here for their horses, they have two little girls. One is [PII] and one is [PII]. And uh that's what they do. They just pass it around. The kids will start.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Then it goes to the parents and by it through with the parents, it's back to the kids.
[AGENT][POSITIVE] Something else came back, yes, exactly.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, I don't want to keep you any longer, and I thought you'd be back.
[AGENT][POSITIVE] You're right. No, it's a pleasure. I'm so glad I got to speak with you again.
[CUSTOMER][POSITIVE] Yes, but he, I was gonna tell you, he loves, of course, he's the football guy, loves all the football.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But now he's gotten to where he loves the girls softball and uh we don't.
[AGENT][POSITIVE] They've been doing really well.
[CUSTOMER][MIXED] 00, it's awesome what they're doing. But up here, we don't get, uh, all of the games, some the streaming stuff we don't get.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm. Oh.
[CUSTOMER][NEUTRAL] And so I just wondered if you watched them also. Well, I hope your little one gets better.
[AGENT][POSITIVE] Thank you. I sure appreciate it.
[CUSTOMER][NEUTRAL] Springtime maybe.
[AGENT][POSITIVE] I hope you'll have a good rest of your night.
[CUSTOMER][NEUTRAL] You too, Han, bye bye.
[AGENT][POSITIVE] Alright, thanks, Miss [PII], bye bye.