AccountId: 011433970860
ContactId: f4a9f996-ae52-4436-92f5-1fdda66d99a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463760 ms
Total Talk Time (AGENT): 161031 ms
Total Talk Time (CUSTOMER): 244149 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/f4a9f996-ae52-4436-92f5-1fdda66d99a0_20250602T19:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] over on the care team. How are you?
[AGENT][NEUTRAL] I'm fine thanks how are you?
[CUSTOMER][NEUTRAL] Doing all right, thank you. um I've got a member on the line who's calling regarding um a claim for his cancer policy um, essentially it was for an MRI. He said that um they had already submitted the uh pathology report, um, and they saw that it was stating we couldn't pay the benefit because we needed the pathology report, but I also see a note saying that um.
[CUSTOMER][NEUTRAL] But it's an incomplete claim, so they want kind of a deeper look at that and what's going on and what they can do.
[AGENT][NEUTRAL] OK, what was the policy number?
[CUSTOMER][NEUTRAL] It is 0252.
[CUSTOMER][NEUTRAL] 5064
[AGENT][NEUTRAL] OK, and what was the claim number?
[CUSTOMER][NEUTRAL] Uh, let's see, 359-023-7.
[AGENT][NEUTRAL] OK, and do you have the callback number?
[CUSTOMER][NEUTRAL] Yes, uh, that is, give me just a moment. Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and you said it's Mr. [PII] on the phone?
[CUSTOMER][NEUTRAL] Yes, we are speaking with him.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Alright, you ready for him now?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] Thank you for holding, this is [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Uh, yes, Mr. [PII], this is [PII]. Um, how can I help you today?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hey, [PII]. Um,
[CUSTOMER][NEUTRAL] So the other girl didn't, I gotta tell, OK. Um.
[CUSTOMER][NEUTRAL] So basically, I just got through telling the other lady about we had tried to file a claim for an MRI but it got turned down because it said it didn't have a pathology report.
[CUSTOMER][NEUTRAL] But we've already submitted a pathology report that showed that I have prostate cancer or had prostate cancer has been removed now. But um
[CUSTOMER][NEUTRAL] But anyway, we, whenever the, my wife was talking to the lady before to tell her that the uh pathology report has already been submitted, they could not
[CUSTOMER][NEUTRAL] do anything because I wasn't there.
[CUSTOMER][NEUTRAL] They wouldn't, like, I don't know, apparently, you could, you could access the pathology report but you couldn't because I was not there to give consent, consent or something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. So you had a question regarding if we received your pathology report, is this regarding your imaging benefit?
[CUSTOMER][NEUTRAL] Yeah, well, I mean, I'm just like what do we need to do to make this happen? I mean, uh, it's.
[AGENT][NEUTRAL] I, I can take a look at that for you. Um, so, so this was, you had the imaging, the MRI was the date of service [PII].
[CUSTOMER][NEUTRAL] Yes. Yes, ma'am.
[AGENT][NEUTRAL] OK. Uh, so yes, we do have
[CUSTOMER][NEUTRAL] And I also had, I also had a pet one.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Yes, sir. Um,
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Uh, yes. So, I do see that it looks like that we did receive that itemized bill for [PII]. And we do have the pathology report. Um, the date that we have on the pathology report that confirmed your diagnosis was after the MRI, um, that was on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So for that imaging benefit, you would have had to have been diagnosed with, with cancer prior to that that imaging um treatment having occurred.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if you had a separate imaging after [PII], since that was your diagnosis date, then we'd be able to review that for that imaging benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then we need to, so we were kind of wondering if maybe that was the hiccup, um.
[CUSTOMER][NEUTRAL] And so I had a PET scan.
[CUSTOMER][NEUTRAL] After that date that we would like to submit.
[AGENT][NEUTRAL] Sure, yes, sir, if you could send that itemized bill to us for review and then we can review that for you.
[CUSTOMER][NEUTRAL] Hey, this is his wife and I'm, I've been trying to log in. I've never had any problem before on y'all's website and because I was gonna look at the status of the claim and all the stuff and pull that up and when I go to sign in and it looks different than what I remember it looking before I don't know if y'all have updated it and when I go to put in and when I put in what I'm pretty sure it was a password I.
[CUSTOMER][NEGATIVE] It doesn't work. It says can't find this account and so I did the forgot your password and it sends a code to the email and it says OK verified your email but then it still says can't find the account and so I'm and I'm doing it for his and mine because we both have one and I'm like I, I don't know what's going on if there's something going on with the site today or or or what because I can't upload it because I don't, it's not it's not even letting me sign in.
[AGENT][NEUTRAL] Yes ma'am, so we, we did update our site, um, with new features on our OSC and so what you'll have to do is just go ahead and just register again for the new site with your information and it would you basically you have to re-register um instead of using the same information and then they.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Be able to to get you back up loaded um on your account uh because yes we did update it with some nice new features for you guys and so um and if you have any issues with reregistering uh please just feel free to give us a call and we'll and we'll help walk you through it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, I started to do that a while ago and I was like, I know I've done this, I'm not crazy. And then I thought, no, I don't need to, and it, I think it said something, I don't remember. I was doing it while he was on hold earlier. So, OK, I'm sure I can get it figured out.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, sure. Yes, ma'am. Uh, was there anything else I could do? Oh, yes.
[CUSTOMER][NEUTRAL] And so let me ask you, do you
[CUSTOMER][NEUTRAL] On this, for this, do I just need to upload the um the itemized bill for the PET scan? Do I need, is there a wellness form or do I have to upload the pathology again or or just a bill?
[AGENT][NEUTRAL] Uh, just the itemized bill would be fine and if you upload it on your site, then you'll go directly into the account for review, um, but if you were to send it by mail or by fax, then I would just be sure to to include the policy number somewhere on the form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. I should hopefully be able to get it done on here so I just wanna make sure if it needed to have something else attached to it.
[AGENT][NEUTRAL] Uh, yes, no, ma'am. Uh, just that itemized bill that just shows the date of service and the CPT codes, um, that, that would be sufficient.
[CUSTOMER][POSITIVE] OK, that works thank you so much.
[AGENT][NEUTRAL] Uh, sure. Is there anything else I could do to help you today?
[CUSTOMER][NEUTRAL] No, I believe that's all.
[AGENT][POSITIVE] Thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] No way, mm.
[CUSTOMER][POSITIVE] Uh-huh. Thank you.
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] Oh.