AccountId: 011433970860
ContactId: c11b965d-9d3d-416e-9b90-85a17a956b00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1515969 ms
Total Talk Time (AGENT): 407953 ms
Total Talk Time (CUSTOMER): 663349 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/c11b965d-9d3d-416e-9b90-85a17a956b00_20250529T15:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm trying to check on a claim. I'm, I'm confused.
[CUSTOMER][NEUTRAL] What should I give you my name first or or what?
[AGENT][NEUTRAL] Sure I could check on that claim for you um yes what was your name please?
[CUSTOMER][NEUTRAL] Uh the last name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] OK, I'm sure I do hear somewhere.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see where is that written.
[CUSTOMER][NEGATIVE] I wouldn't have been written.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Account number, no, no policy number.
[CUSTOMER][NEUTRAL] Let's see, is it on the farm?
[AGENT][NEUTRAL] Or if you um if you have the claim number uh I could take that too.
[CUSTOMER][NEUTRAL] Oh, OK, wait, I'm looking at the form they sent in.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Medical record number, no, what was the other question I could give you? What was it?
[AGENT][NEUTRAL] It's OK, uh, policy number, claim number or if it's easier I can also start using your social.
[CUSTOMER][NEUTRAL] OK, how about the social? I don't know why I'm not putting my hand on it. See.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know. I'm just not putting my hand on it.
[CUSTOMER][NEUTRAL] Uh, social, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alrighty there we are, uh, and then [PII] just gonna verify some information really quick. Can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying all of that. OK, so the claim that we're looking at, is this for your critical illness policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's take a look, OK.
[AGENT][NEUTRAL] And did you just have a question on one that was recently submitted?
[CUSTOMER][NEGATIVE] Yes, I mean, is it, I'm confused because, because $5000 showed up in my bank account. I'm confused about that.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, got you. That's probably, let's take a look here. Give me just a moment.
[CUSTOMER][NEUTRAL] Well that
[AGENT][NEUTRAL] I was thinking about it.
[CUSTOMER][NEUTRAL] Plus I still have
[AGENT][NEUTRAL] I apologize, bear with me just a moment. It's not wanting to work for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, honey.
[AGENT][NEUTRAL] There we are, OK, got it. OK, so yes, um, it does look like you had set up direct deposit. I see this, uh, for the date of service was [PII], and let's see exactly what that benefit was.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] Bear with me, I appreciate your patience. I'm just trying to find exactly what this was. It's obviously one was uh um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] qualifying critical illness that you received treatment for.
[AGENT][NEUTRAL] I'm just trying to see exactly which one that one is.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] There we are. OK. Uh, looks like that was for non-invasive cancer.
[AGENT][NEUTRAL] Does that sound right to you?
[CUSTOMER][NEUTRAL] Non-invasive.
[CUSTOMER][NEGATIVE] Mm, I mean, it's, well wouldn't mind, well, I can't find the policy. Is that all it pays for cancer? I thought it paid more than that.
[AGENT][NEUTRAL] Uh, so for noninvasive cancer that benefit was $5000.
[CUSTOMER][NEUTRAL] And that's it.
[CUSTOMER][NEUTRAL] That's not the way I read the policy. I is the policy. So it has to spread to your pelvis and your liver.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] Noninvasive, what the definition is, don't know.
[AGENT][NEUTRAL] Um, I can get that pulled up. We can take a look. Give me just a moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So my computer is just in just no hurry today. I don't know what the deal is.
[CUSTOMER][NEUTRAL] That happens.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let's see, let me look at my.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause they don't tell you a lot on the policy.
[CUSTOMER][NEUTRAL] That's why you don't really know.
[AGENT][NEUTRAL] Well, it is a bit confusing. There's typically sections that will, uh, state, of course, what the benefit is and how much it would pay, uh, and then there's other parts that go deeper into the actual definitions of those things.
[AGENT][POSITIVE] That's what I'm trying to get that pulled up whenever you know whenever it feels like working with me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] This policy doesn't take anything.
[CUSTOMER][NEUTRAL] OK. Try something else.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][POSITIVE] I'm so sorry. I'm doing my best to get this pulled up as quickly as I can.
[CUSTOMER][NEUTRAL] OK. It's OK, honey.
[CUSTOMER][NEUTRAL] No hurry.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oops.
[AGENT][POSITIVE] My goodness, there we go. OK, I got the policy pulled up so I'll get more into this particular benefit. I really appreciate your patience.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] So I got a version of it pulled up too finally.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] OK, we find cancer on it.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] I don't know where it is. Oh, skin cancer, no.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] I had that already.
[CUSTOMER][NEGATIVE] I don't see this cancer.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] These kinds of policies, they are so specific so I gotta find the right thing.
[CUSTOMER][NEGATIVE] Must be the wrong thing I'm looking at because I don't even see, oh, I see a skin cancer. I know that's not it. They have more than that.
[AGENT][NEUTRAL] So just so that I understand correctly, would, do you believe that the, what you have was invasive cancer?
[CUSTOMER][NEUTRAL] Well, what's the definition of invasive?
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I mean it's
[CUSTOMER][NEUTRAL] It's in my thigh. It's invaded my thigh, all my muscles, but we can't take that out. So we took the extension out the part that was growing next on that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here is what I'm going to do, Miss [PII], just, um, kind of save us both a bit of time. I'm going to reach out to our claims specialist so that they can provide some clarification regarding this because, um, my computer just gone slow as I'll get out and frankly I'm not really seeing anything myself so I'm going to see.
[CUSTOMER][NEUTRAL] Yeah, I don't even see cancers on it.
[AGENT][NEUTRAL] Yeah, usually I can just search for a specific um.
[CUSTOMER][NEUTRAL] Oh, I see a little.
[AGENT][NEUTRAL] Definition regarding that, but.
[AGENT][NEUTRAL] All I'm really seeing is, uh,
[AGENT][NEUTRAL] Yeah, I don't see, I don't see cancer. That is interesting. Yeah, if you wouldn't mind, give me just a moment. I'm gonna put you on a brief hold, um, and then I'll get right back with you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] OK, honey.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good how are you [PII]?
[AGENT][NEUTRAL] Doing all right. So I got a, got an odd one. I've got someone calling um I'm sorry, I know.
[CUSTOMER][NEUTRAL] Oh gosh.
[AGENT][POSITIVE] Well, you might know, listen, no, no, no, you're better than me, so you might look at this and just be like, oh yeah, that's it, so that's what I'm hoping for.
[CUSTOMER][NEUTRAL] Come on, [PII]. No, I'm just kidding.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I've got a member she filed a claim and for a critical illness policy and she got a $5000 benefit and she's was confused by it. So I looked under the PIBFT and from that little benefit name it says it's for noninvasive cancer, and she's saying that she doesn't understand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That specific definition because she said that she doesn't understand how, what she had was non-invasive. So I, she said it was like in her thighs or something like that, like they had to take muscle out. Um, but I looked in the policy, and I swear I don't see anything regarding any kind of cancer under the policy. Like I tried searching, I tried doing all kinds of like scrolling. I see absolutely nothing.
[CUSTOMER][NEUTRAL] OK, yeah, let's definitely take a look. What's that policy number?
[AGENT][NEUTRAL] OK, uh, 02271224.
[CUSTOMER][NEUTRAL] So that's 227-1224?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mildred is the primary.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's her accident policy.
[AGENT][POSITIVE] Oh, I'm sorry, yep, uh, that was the first one that she had to give me her social. I just saved the first one I could.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][POSITIVE] That's OK. I found the other one you're good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let's see.
[CUSTOMER][NEUTRAL] So I'm going to look at her policy first to see what it says and then.
[CUSTOMER][NEUTRAL] And then we're gonna see if there's anything else out here we can look at.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Noninvasive, so she feels like it may, it should have been considered like invasive cancer, which is a $20,000 benefit. I mean, that's a significant difference, so I can understand her being like, hang on a second.
[AGENT][NEUTRAL] That's what
[AGENT][NEUTRAL] Right, and that's what I asked her. Well, and I think it's more she just wants clarification as to what we define as invasive versus noninvasive, um, because again she said it like was in her thighs and all that so and usually I'm like, well, the definitions in the policy and I can't find it.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK, yeah, that's definitely a problem, isn't it? Um, let's see.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Page 21 in the policy, well, it's page 18, but if you're looking at on base, if you'll go to page 21.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Invasive cancer is defined as a malignant tumor characterized by the uncontrolled growth and spread of malignant cells as well as invasion of neighboring tissue.
[AGENT][NEUTRAL] Oh my gosh, you know what I'm doing?
[AGENT][NEUTRAL] [PII], I'm looking at the Dam accident policy. Oh my gosh.
[AGENT][POSITIVE] I am so sorry.
[CUSTOMER][NEUTRAL] And then noninvasive. That's what I, so noninvasive is characterized by tumor cells that lie within the tissue but have not spread to neighboring tissues. So that's gonna be like introductal carcinoma of the breast, carcinoma of the appendix, stage one transitional carcinoma of the bladder, chronic um lymphocytic leukemia.
[CUSTOMER][NEUTRAL] Stage one malignant melanoma. So let's see what she had because that's going to kind of be.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The trick there too.
[AGENT][NEUTRAL] I cannot believe I'm looking at the there, yeah, OK. I'm like, why am I not getting anything for cancer when I'm searching this? It's clearly a benefit. I cannot believe my phone.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I say I'm not with it, but listen, like there's no excuse for this.
[CUSTOMER][NEUTRAL] Oh, so she had.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] It's OK. Look, it's Thursday. I don't know how it is where you're at, but it has been very rainy and overcast and a little cooler than normal, so you know what, my brain's not hot there either.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], yeah, same.
[AGENT][NEUTRAL] Yeah, exactly the same.
[AGENT][NEUTRAL] No, I'm like it was just be Friday.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So she had malignant neoplasm of connective and soft tissue unspecified.
[CUSTOMER][NEUTRAL] Um, so we are going to try to determine if that is invasive or not.
[CUSTOMER][NEUTRAL] OK, so Doctor Google says that it is, but let's see what her.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let's see what her actual.
[AGENT][NEUTRAL] That's the my first consultant too, honestly.
[CUSTOMER][NEUTRAL] Plain says.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I'm gonna see what this is because there's an email for this and I'm wondering if it's a medical review.
[CUSTOMER][NEUTRAL] It's not saved as a medical review, but it could be.
[CUSTOMER][NEUTRAL] Oh my goodness, OK, uh.
[CUSTOMER][NEUTRAL] Oh no that was just her request for.
[CUSTOMER][NEUTRAL] EOB OK.
[CUSTOMER][NEUTRAL] Or somebody's request, maybe the broker OK let's see.
[CUSTOMER][NEUTRAL] I'm gonna pull up that definition again too.
[CUSTOMER][NEUTRAL] So she has malignant neoplasm.
[CUSTOMER][NEUTRAL] So stage one malignant melanoma.
[CUSTOMER][NEUTRAL] That has like certain.
[CUSTOMER][NEUTRAL] Thickness and everything is not so.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Non-invasive cancer does not include premalignant tumors or polyps, any non-melanoma skin cancer. So let's go back to invasive and see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Disease must be supported by histological evidence of malignancy, clinical, I mean, the fact that it says malignant neoplasm.
[CUSTOMER][NEUTRAL] Tells me
[CUSTOMER][NEUTRAL] Invasive cancer does not include premalignant tumors or polyps, any non-melanoma, skin cancers, or a non-invasive cancer.
[CUSTOMER][NEUTRAL] OK, so it's a little more vague.
[CUSTOMER][NEUTRAL] Let's see what her information gives us. It may just be a matter of.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because this wasn't sent for medical review.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which Dehay is usually like really really.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Let's see what that is because that is what is on the physicians.
[CUSTOMER][NEUTRAL] It's a rare cancerous tumor that develops from fat cells in the body's soft tissue. It's a soft tissue sarcoma, meaning it originates in the non-bone tissue and can occur in various locations.
[CUSTOMER][NEUTRAL] But is most often found in extremities, specifically the thigh which she was saying that's where it was.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It can spread, but the question is, has it?
[CUSTOMER][NEUTRAL] That's gonna be the trickier because if she just had because that's the language in the policy that we're looking at for invasive it has to be a a malignant tumor that has uncontrolled growth and it has spread.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Into neighboring tissue if her cancer was localized to the tumor.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] That could be where the difference is.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so I was trying to see what other that's just her physician's form, so let's go to what was submitted prior to that.
[CUSTOMER][NEUTRAL] Looks like we've got some other stuff that was submitted around the same time, but I don't know that it's for her. OK, let's see what this is.
[CUSTOMER][NEUTRAL] Girl, it has been raining since like [PII] this morning and it ain't stopped yet.
[AGENT][NEUTRAL] Are you in [PII]?
[CUSTOMER][NEUTRAL] And I saw something
[CUSTOMER][NEUTRAL] No, I'm in [PII].
[AGENT][NEUTRAL] Oh, OK. Yeah, I'm in [PII].
[CUSTOMER][NEUTRAL] But like on the east side of [PII], I'm like right next to [PII].
[AGENT][NEUTRAL] 00, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I literally could like I feel like I could throw a stone and be like, oh, there's [PII], like it's not far at all.
[AGENT][NEUTRAL] That's like my mom lives in uh [PII], that's how I feel. I'm like it might as well be [PII] like.
[CUSTOMER][POSITIVE] Right, exactly.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Um, left the additional tumor, so they took out.
[CUSTOMER][NEUTRAL] A mass, and then, so they took out two masses.
[CUSTOMER][POSITIVE] Both of which were well differentiated liposarcoma.
[CUSTOMER][NEUTRAL] Um, based on her past report.
[CUSTOMER][NEUTRAL] Trunk tumor sat was in her left thigh.
[CUSTOMER][NEUTRAL] It was pretty big.
[CUSTOMER][NEUTRAL] Oh this is so the notes show lymphatic and or vascular invasion were not identified, um, and all margins essentially, so when they go in and this is true for anywhere because like I've had a mole removed that was suspicious for cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it wasn't just like a sha's biopsy like they took a parameter basically so they took tissue around it and scooped it out of my leg so that way they get like a good margin to see, OK, if this is cancer, are there margins clear of the cancer where it's at? So what likely happens.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] As they went in and with this being in the soft tissue or within the muscle or whatever, they probably did take margins significantly around this tumor because I mean it wasn't small, it was 14.8 centimeters in dimension so it was not tiny um.
[AGENT][POSITIVE] Oh, wow.
[CUSTOMER][NEUTRAL] So they likely did take a decent margin around that and almost did like a scooping top section to make sure that OK we know that this particular site is cancer however we wanna make sure that it's localized to that area.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So that is the difference is that invasive, it has not spread, the cells have not spread beyond the tumor, which makes it noninvasive. It's not that it's not malignant. It's not that it's not cancer. It's just by the definition, it's not considered invasive yet because it is localized to the tumor itself and not spread, yeah.
[AGENT][POSITIVE] They got it right there. Yeah. OK.
[AGENT][NEUTRAL] Right. OK. That's interesting. Would you mind explaining that to her?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] No, not at all.
[AGENT][POSITIVE] I appreciate it. Well, you're a bit more well read when it comes to that.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I don't mind at all. Let me get her a call back just in case um.
[AGENT][POSITIVE] Alright, I appreciate it. Oh yeah, yeah, let me get that. Um, that is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I will talk to her.
[AGENT][POSITIVE] Alright, I appreciate you, [PII], thank you.
[CUSTOMER][POSITIVE] No problem, you're welcome.
[AGENT][NEUTRAL] All right, bye.
[CUSTOMER][NEUTRAL] Bye bye.