AccountId: 011433970860
ContactId: 9a4bd24a-0b23-4bca-b3f8-9a2789504029
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595799 ms
Total Talk Time (AGENT): 265669 ms
Total Talk Time (CUSTOMER): 212408 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/9a4bd24a-0b23-4bca-b3f8-9a2789504029_20250128T15:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], I was just checking on, they said that my claim was complete and I was just trying to see if that was both of the claims or is that was that on just one.
[AGENT][NEUTRAL] Can I have your name?
[CUSTOMER][NEGATIVE] You're breaking up on me.
[AGENT][NEUTRAL] Um, sorry about that. Can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can hear you now.
[AGENT][NEUTRAL] OK, can I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. What's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what's your policy number?
[CUSTOMER][NEUTRAL] Policy number is 709252.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, Ms [PII], and verify your address and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you and also verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright thank you and you're calling for claim status, right?
[CUSTOMER][NEUTRAL] Yes, well, I, I got one and said one was complete, but I, I sent in two and I'm just wondering if this was both of them together or what.
[AGENT][NEUTRAL] OK, sure, and yep, those um both claims have been processed and it's all under one claim.
[CUSTOMER][NEUTRAL] OK, and so is that the one I sent in for 4:30 and they paid 50?
[AGENT][NEUTRAL] Let me take a look at that.
[AGENT][NEUTRAL] Cause it looks like we're asking for additional information. So the only thing paid was the wellness benefit, the diagnostic testing for the mammogram.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But I see we are requesting a pathology report.
[CUSTOMER][NEUTRAL] I, I sent a pathology report. Mhm.
[AGENT][NEUTRAL] 4.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, but saying we don't have that give me a moment, I'll pull up what we have on file to see if I can see it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on one of those submissions I show the bills, the itemized bill, that's 7 pages and OK.
[CUSTOMER][NEUTRAL] Yeah, I sent 2 itemized bill and a pathology report.
[AGENT][NEUTRAL] Alright, I'm pulling up the 2nd 1 now.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] All right. So I show the MRI results.
[CUSTOMER][NEUTRAL] Yes, it's on there too.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEGATIVE] But it's a page, it's just a blank page, I mean a big white page and it has pathology report on top and then it lists everything.
[AGENT][NEUTRAL] All right. So, yep, I do show that pathology report from [PII]. But based on that, there was also a biopsy on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So did, yeah, so that would be the initial pathology report that's needed.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] You need a pathologist report on
[CUSTOMER][NEUTRAL] For the [PII], I was told that the pathologist report that I sent in with everything that Doctor uh [PII] and Doctor [PII] sent.
[AGENT][NEUTRAL] Yeah, so based on that, so it'll determine.
[AGENT][NEUTRAL] Your benefits for anything prior to [PII], the biopsy that we have on file. If we start from that date, that'll be the date of diagnosis and any services prior to that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] would not be covered because it doesn't show that there was cancer uh prior to [PII]. So we get that pathology report that shows [PII], then you'll be considered for benefits starting from [PII].
[AGENT][NEUTRAL] Because right now,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As the claim is, there's some uh benefits for the
[AGENT][NEUTRAL] Date of the biopsy that's considered a surgery on [PII] plus the facility um.
[AGENT][NEUTRAL] Benefits. So it's multiple benefits that you will not receive if we process it based on the [PII] date.
[CUSTOMER][NEUTRAL] OK. OK. So if I, if I need, I need.
[CUSTOMER][NEUTRAL] You have to tell me exactly what you would want the doctor to send you.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] We need a pathology report.
[CUSTOMER][NEUTRAL] So I need anything.
[AGENT][NEUTRAL] The pathology report from the biopsy on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I mean, I could do that. I, but the one that was paid that was for the 200 or the 230.
[AGENT][NEUTRAL] Let me see, so no, the, the only, yeah.
[CUSTOMER][NEUTRAL] I sent in the itemize.
[AGENT][NEUTRAL] So the rest of those benefits are on hold waiting for the pathology report from [PII]. The only benefit that was paid on this claim was your diagnostic benefit, um, that $50 that was for the the benefit for the mammogram. But the rest of your benefits, we're waiting for the [PII] pathology report in order to release those benefits.
[CUSTOMER][NEUTRAL] OK, so [PII], the pathology report.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, I can see if I can get that for you.
[AGENT][NEUTRAL] OK. And um just to be sure to avoid.
[CUSTOMER][NEUTRAL] And I'll, I'll send it in.
[AGENT][NEUTRAL] Um, any unnecessary information sending it to us on the first biopsy you received on [PII]. Do you remember or know if that was a positive diagnosis of cancer?
[CUSTOMER][NEUTRAL] The note, the very first one that I got was, yeah, that [PII] and that's when they.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] diagnosed the very first thing of uh the disc.
[AGENT][NEUTRAL] OK, yeah, so we need that.
[CUSTOMER][NEUTRAL] And then after that I went through, yeah, I went through.
[CUSTOMER][NEUTRAL] Everything after that, I, they just kept doing mammograms and biopsies and
[AGENT][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] Just everything. I've had all kinds of.
[CUSTOMER][NEUTRAL] Yeah, but at first, um,
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] That pathology report that I that I sent was from
[CUSTOMER][NEUTRAL] Was it from Doctor [PII], Doctor, I don't have them in in front of me. Doctor [PII], um, Doctor [PII], but she's a, she's the surgeon.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I would have.
[CUSTOMER][NEUTRAL] Surgery on the [PII].
[CUSTOMER][NEUTRAL] So those that pathology report.
[CUSTOMER][NEUTRAL] Came from
[CUSTOMER][NEUTRAL] Doctor, my oncologist.
[CUSTOMER][NEUTRAL] After everything had been done.
[AGENT][NEUTRAL] Yeah, understood, yeah, so.
[CUSTOMER][NEUTRAL] He was the one that did that, yeah, that.
[AGENT][NEUTRAL] Yeah. So we're gonna need that [PII] pathology report. And then uh once we receive that, then we can process the rest of your benefits and you could expect um your benefits that are due to you more than that $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, well, I was just wondering if that was it so I, I, I can notice that that when it comes in that that that's the total.
[AGENT][NEGATIVE] Yeah, no. Not at all.
[AGENT][NEUTRAL] That's just what we were able to pay based on the information we have so far, but only things missing is that [PII] pathology report and then that'll basically open the door for the rest of your benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'll get that for you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, good deal. Well, is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Oh no, that would be all, that would be all. Thanks so much.
[AGENT][POSITIVE] No problem, thank you for calling APL have a great day.
[CUSTOMER][POSITIVE] Appreciate it.
[CUSTOMER][NEUTRAL] Mhm you too.
[AGENT][POSITIVE] Thanks bye bye.