AccountId: 011433970860
ContactId: 63235ac1-8e0c-432f-85a4-f3b98800127d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641690 ms
Total Talk Time (AGENT): 346872 ms
Total Talk Time (CUSTOMER): 293501 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/63235ac1-8e0c-432f-85a4-f3b98800127d_20250214T20:42_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 was returning your phone call. I missed it earlier today.
[AGENT][NEUTRAL] Hi [PII] how are you?
[CUSTOMER][POSITIVE] I'm great and yourself?
[AGENT][NEUTRAL] I'm good, thank you. Um, I, I'm actually working on your claim right now. Just verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And your address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I wanna apologize in advance. I really don't know what I'm doing with all this, so I'm just uploading everything, I think.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] That's absolutely OK. Um, I have been through everything and I was able to um release payments for the benefits where we had enough of information to uh make a claim decision.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The only thing that is
[AGENT][POSITIVE] I would say outstanding and what you're gonna receive correspondence requesting the additional information, um.
[AGENT][NEUTRAL] And I just wanted to ask some questions.
[AGENT][NEUTRAL] Um, regarding the treatment just to, to follow the story with the filing. Right now, the question is the initial diagnosis, the date in which the first cancer diagnosis was um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Received
[CUSTOMER][NEUTRAL] OK, so they had me come in, they detected, you know, they did like their biopsies and everything, and they said it had like a 60% chance and then they did something else and they said it had a 90% chance. It wasn't until I had the surgery, which I believe was like [PII] or something like that or [PII] or somewhere around there. Um, and then they actually removed the thyroid and then that's when they, um, did whatever.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The biopsy is like in more intense or whatever one. I'm, I'm sorry, I'm not a medical person, but they, um, yeah, so they, when they took it out and they tested it and that's when they confirmed that yes, it was cancer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, understood.
[AGENT][NEUTRAL] OK. And that is what I needed to clarify because um I saw that surgery of the thyroid removal in February and then I saw the pathology report for March. And so I processed the claim as requesting the initial pathology report because just based on the information, it looks as though there was a diagnosis and that's why the thy thyroid was removed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I can go ahead and process.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] The first occurrence benefit based on that information and I'll make a note on your policy. The only other thing, well, if the diagnosis was in March.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, no. We don't have a pathology report from the [PII] surgery.
[CUSTOMER][NEUTRAL] They have, I know they sent it off even at to.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] They like sent it and it took a couple of weeks before they gave a final answer like for some reason like I don't, it's like they had to send it off to like another report or another like a hospital thing or something or a.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, I don't know who do I ask? Like, I don't know who to like how to answer that really.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Your uh.
[CUSTOMER][NEUTRAL] I just like I'm just like you tell me what to do and I'll do it and then I'll just, you know what I mean like I just stay in my lane.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I understood. Yeah. So the pathology report, if there's an online portal with the facility, um, it's typically in your chart under your test results, or you can reach out to your doctor, be it your primary care or um oncologist if you see
[AGENT][NEUTRAL] One of those. But it would be from a doctor. Whatever doctor you go related to, go to, related to your surgery, I'm sorry, your cancer. Um, you would just let them know that you need the pathology report from that surgery.
[CUSTOMER][NEUTRAL] OK, so that's what I asked them. That's what I asked them for is the pathology report and they supposedly sent it. It said an FB like 123 and 4.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I thought that was the pathology reports. That's what they supposedly sent me.
[AGENT][NEUTRAL] Now we have
[AGENT][NEUTRAL] Yeah, we have a uh pathology report on file that you submitted, but that was for um [PII] and it looks like uh related to the breast.
[CUSTOMER][NEUTRAL] Oh no, the, in [PII]?
[CUSTOMER][NEUTRAL] I just found out I have breast cancer in [PII].
[AGENT][NEUTRAL] No, this
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, my apologies. So yeah, uh, [PII] is the pathology report that we have. And then the only other pathology report we have is for um
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] But the surgery was on.
[CUSTOMER][NEUTRAL] That one would have to be the
[CUSTOMER][NEUTRAL] Yeah, they removed it before they 100% confirmed they knew, they knew it was, they thought it was cancerous. They were saying it was a 90% chance that it was cancerous, but until they could take it out to confirm the, the actual results, so [PII] makes sense because like I said, it took a, I think it took a couple of weeks before they actually.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like the biopsy, you know what I'm saying? They did biopsies and they were saying, first they said a 60% chance and then they did something again and they said it was a 90%, they sent it off somewhere, I think is what it was. And then they said it was a 90% chance and they were like, so we need to go ahead and, um, take it out because, and plus it was also pushing against my esophagus anyways. You know what I mean? Because it was so big. And they were saying that they, they believed it was cancerous. And so then when they took it out at the end of February,
[CUSTOMER][NEGATIVE] Then they sent it off and I believe it had to go to another hospital because I remember it was like a week, I still didn't get it for another week past what I should have gotten it.
[CUSTOMER][NEGATIVE] Because they had to like send it to, it was like a real weird results is what they were having a hard time reading.
[AGENT][NEUTRAL] Understood. Um.
[AGENT][NEUTRAL] The only thing with that, yes, it is a, a turnaround time, but that pathology report shows the date in which the specimen that's being tested was collected. And
[AGENT][NEUTRAL] That's what we need, a pathology report that shows the collected date of [PII].
[AGENT][NEUTRAL] What I would suggest to take the guessing out of the equation on your end because I know that can be a lot. Um, go ahead and send in any pathology reports that you have, um, from the first, even if
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I've sent you everything they've given, they've given me.
[CUSTOMER][NEUTRAL] I've uploaded everything that I can find. So do I need to call the hospital again and say I need a pathology report from the surgery in February because I thought that's what they sent me, that's what I asked them for.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I still have it in front of me and I have been through.
[CUSTOMER][NEUTRAL] Hold on a second, what did you say?
[CUSTOMER][NEUTRAL] I'm on the phone, OK, go ahead, what were you saying?
[AGENT][NEUTRAL] Yeah, I have the claim up in front of me now and I have been looking at all of the documents and I'm looking for that uh February pathology report and it's just not here. And that um that is a bulk of your claim payment, that first occurrence benefit. So we, we need that information in order to release that benefit. As I stated, I've paid for uh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Some
[AGENT][POSITIVE] Wellness benefits and also imaging, but the big chunk of your benefits will be for that first occurrence benefit.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] But we need that pathology report from the surgery on [PII].
[CUSTOMER][NEUTRAL] OK, so I'm, I'm gonna write down what and figure out what you're telling me to ask. OK, so February, so is it February, so I need to ask for a pathology report.
[AGENT][NEUTRAL] Yes, from, uh,
[CUSTOMER][NEUTRAL] From the surgery time uh in February.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] because I saw two surgery charges in [PII] 1 was on [PII], but there was no details. So, um, there's a [PII] and a [PII].
[CUSTOMER][NEUTRAL] To ask them for that.
[CUSTOMER][NEUTRAL] Let me see, I think my.
[CUSTOMER][NEUTRAL] Let me see what was in [PII]. I don't remember.
[CUSTOMER][NEUTRAL] Mm, OK, February.
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] I don't know why it says [PII]. I wasn't, nothing happened on the [PII]. The surgery did happen on the [PII].
[AGENT][NEUTRAL] OK. All right, so that.
[CUSTOMER][NEUTRAL] Unless maybe I went in to do some kind of a blood work or uh you know what I mean, some kind of something.
[AGENT][NEUTRAL] And it is possible, but it's hard to um tell exactly what it is because it's not coded. But yeah, that's absolutely fine. So what we're looking for is the [PII] pathology report, as well as the surgeon's bill, so you can get paid for um benefits for that surgery, a biopsy as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need to go to [PII] for that. You know what, that might be where the, because [PII] was the surgeon, and that may be who has the actual pathology thing there and I haven't even called his office, so that, that may be OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so that's what.
[AGENT][NEUTRAL] I would suggest getting on that because it, it's a lot of information we received and I wanted to give you a call because um the benefit payment that's going out and um compared to the documents you sent, I didn't want you to be alarmed like, hey, is this it? We just need that one piece.
[CUSTOMER][NEUTRAL] OK, alright, well, I will contact Doctor [PII]'s office and I'll see if they have the pathology report and an and an itemized bill, is that what you said?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Itemized surgeon's bill, yes.
[CUSTOMER][POSITIVE] OK, I will ask for both of those. Thank you so much. I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, no problem, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] All right, well thank you for calling APL and you have a great day.
[CUSTOMER][POSITIVE] Thank you. I appreciate it. You too.
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] Bye.