AccountId: 011433970860
ContactId: edec9dbe-2042-4050-835c-77887df9858d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421260 ms
Total Talk Time (AGENT): 171703 ms
Total Talk Time (CUSTOMER): 130585 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/edec9dbe-2042-4050-835c-77887df9858d_20250224T18:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, I was calling about, um, my mother's policy. Um, I had spoken with someone a couple of weeks ago wondering about if her, if she could have her some of her long-term care covered. And in that call, they looked up and saw that, that she, her, whatever I had sent in for her MRI reports had been um
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I guess declined or whatever, um, because she had no pathology. And so I just kinda wanted to check, check on things.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, we can get that policy pulled up and see if we can get some clarification on that. Um, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It it is 112479.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And uh who is this regarding? I'm sorry, the name of the insured?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I'm just gonna verify some information really quick, [PII]. Uh, can I get [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get the mailing address we've got on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file uh looks like it's a Gmail account.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] Perfect. OK, thank you so much for verifying that information. Give me just a moment here.
[AGENT][NEUTRAL] OK, let me take a look just for good measure for this claim.
[AGENT][NEUTRAL] OK. Um, so is [PII], um, does she currently have cancer?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Is she a cancer patient? Is that what this is in regard to?
[CUSTOMER][NEUTRAL] She was, yes.
[AGENT][NEUTRAL] OK, uh, and so this, uh, the claims that were being filed, that was from cancer treatment, is that right?
[CUSTOMER][NEUTRAL] The only, I have not filed a claim. All they told me to do was, since I didn't have a pathology report, because they weren't able to do that, I sent in the results from her MRI and CT scans. Um, I was just starting, starting there because we had just found out about the policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I see. OK. Um, so you don't have the pathology report or was, was there, um, a biopsy?
[CUSTOMER][NEGATIVE] There is no, there is, there was no biopsy. They were not able to do one.
[AGENT][NEUTRAL] I see. OK. So the MRI is what essentially determined the cancer.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Got you. OK, sorry, I just wanted to make sure that we were on the same page. OK, let's take a look here and see if I can't find and what do you know when that one was sent?
[CUSTOMER][NEUTRAL] Yeah, yeah. Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see, uh.
[AGENT][NEUTRAL] I have the most recent claim as being sent uh [PII]. Does that sound right to you?
[CUSTOMER][NEUTRAL] Um, probably, yes, I'm just looking on here on the website and it says that the date of the scan obviously was [PII], but yes, that would, that would probably seem right, the January date.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. OK, give me just a moment.
[AGENT][NEUTRAL] OK, so it looks like I think this was already, I know you said that you've called us before um and it looks like they were already taking a look at this so if you'll give me just a moment I'm gonna put you on a brief hold, [PII] and I'm going to reach out just to kinda see if there's been a status update on that already.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty give me just a moment. I'll get right back with you, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling AP. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][NEUTRAL] I'm doing OK yourself?
[AGENT][NEUTRAL] Doing all right, thank you. Um, I've got a member on the line, uh, calling regarding a claim they submitted under their cancer policy. Um, long story short, I guess there was no pathology report. The diagnosis of cancer came from an MRI and that claim was denied as needing the pathology report. Um, I see a note where she'd called and spoken with us before regarding it, but I don't know that there's been any update or if she should just appeal this. If you wouldn't mind taking a look at it for me.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] It is 112479.
[AGENT][NEUTRAL] And it is for uh part one.
[CUSTOMER][NEUTRAL] A callback number?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] OK, you can go and send it through.
[AGENT][NEUTRAL] OK, so we're speaking with um [PII], she's the daughter um and she has power of attorney.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][POSITIVE] OK, thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.