AccountId: 011433970860
ContactId: 8fc33b26-22ab-4d17-a3ed-8926b3739d6a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392380 ms
Total Talk Time (AGENT): 111521 ms
Total Talk Time (CUSTOMER): 190484 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/8fc33b26-22ab-4d17-a3ed-8926b3739d6a_20250625T13:32_UTC.wav
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[CUSTOMER][POSITIVE] Wow, give me a.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, my name is [PII]. I had filed a claim on the cancer policy.
[CUSTOMER][NEUTRAL] And uh I got an email last night said it was denied so I'm just sort of.
[CUSTOMER][NEUTRAL] Curious as to why it said the diagnosis wasn't uh good enough or something, so can you help me?
[AGENT][NEUTRAL] Yes, do you have your policy number?
[CUSTOMER][NEUTRAL] Oh, I do somewhere. Let me find it uh.
[AGENT][NEUTRAL] Or I can look it up by your social or?
[CUSTOMER][NEUTRAL] Yeah, you want, you ready?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 435194497
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I
[AGENT][NEUTRAL] OK, and Mr. [PII], can you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then your address and email address.
[CUSTOMER][NEUTRAL] Email is [PII] [PII]. Address is [PII] or [PII].
[AGENT][POSITIVE] OK, thank you so much and then uh do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let me see what we've got here.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so it looks like we got the pathology report, but it did not give a positive diagnosis of cancer. Again, did they just suspect?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No ma'am, I've got I've got definitely got the uh.
[CUSTOMER][NEUTRAL] Large B cell, uh, diffuse large B cell lymphoma, uh, I did a chemo treatment last week. So do I need to get better documentation from a doctor or what do we need to do to push this forward?
[AGENT][NEUTRAL] Yes, because the information we received showed that it was negative. It didn't show a positive diagnosis, so there, yeah, we would need something that shows.
[AGENT][NEUTRAL] that there's an actual diagnosis.
[CUSTOMER][NEUTRAL] OK, so I
[CUSTOMER][NEUTRAL] That's the original uh.
[CUSTOMER][NEUTRAL] Original report that they gave me uh when a doctor first told me I had this, and they also had what they call a fish report that's uh more extensive uh pathology report that they got to send off. It takes them about a week to get it back.
[CUSTOMER][NEUTRAL] I could send you that if that'll help and I will also I've got to call in for my doctor right now to give me a diagnosis and uh a complete report so I can send it back in.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Does that sound like what we need to do?
[AGENT][NEUTRAL] Yes, we would just need something that actually states because that path report that you um had submitted said no significant.
[AGENT][NEUTRAL] Abnormalities detected, no significant reactivity with the markers tested, so it, it didn't indicate that there was um cancer. So that's, yes, that's what we need is something that should, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I, when I, I originally got that report, uh.
[CUSTOMER][NEUTRAL] On what they on the my chart thing that uh doctors and all.
[CUSTOMER][NEUTRAL] Send out to you and I thought the same thing when I saw that. I said well good I don't have it and then when they come back when I went to the see the doctor and the other report they said no you got it so I will gather more information. Do I need to file another claim or how do I need to handle it?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, you'll need to file another claim, um, and then we'll be able to look at the information already submitted and see if if we can process off of that as well, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right well I'm gonna get that together and get it to you.
[AGENT][NEUTRAL] OK. Anything else I can help with today, Mr. [PII]?
[CUSTOMER][NEGATIVE] That was the only thing and also it said that the email said something about uh they couldn't.
[CUSTOMER][NEUTRAL] Pay anything to the uh I guess the lymph node removal because it was not cancerous, but uh.
[CUSTOMER][NEUTRAL] I guess that's not a fact also so I'm gonna um also get all my medical bills and send that in also y'all pay on that too, right?
[AGENT][NEUTRAL] Um, let me see what your policy covers.
[AGENT][NEUTRAL] Uh, let's see, so it looks like, and this is not a guarantee of payment, it's a basic outline of your policy.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][POSITIVE] Yeah, so it looks like we pay for, there's a benefit of 10,000 for radiation, chemo, and immunotherapy. There is a surgical benefit, yes, so.
[AGENT][NEUTRAL] You've got a surgical benefit up to 3000 per operation.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Now should that all be filed on the same claim or should that be filed, uh, can I file it separately or how I need to handle that?
[AGENT][NEUTRAL] Either way it we'll be able to, you know, if we have the necessary information we can process off of it so if you wanna file it all together you can or separately either way, whatever is easiest for you.
[CUSTOMER][NEUTRAL] OK, I'll probably do it separate. I won't definitely get the uh diagnosis straight and get that one rolling in the right direction and then I'll still gathering information for all the other stuff, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good.
[CUSTOMER][POSITIVE] I will get that to y'all.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] All right