AccountId: 011433970860
ContactId: f8fe2eab-2037-4083-9145-e50b5ef4eeb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483019 ms
Total Talk Time (AGENT): 250778 ms
Total Talk Time (CUSTOMER): 282534 ms
Interruptions: 10
Overall Sentiment: AGENT=2.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/f8fe2eab-2037-4083-9145-e50b5ef4eeb2_20250424T15:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. Um, my name is [PII]. I'm calling um in regards to my husband because one, he has no patience with this sort of thing. Um, so, uh, yes, um, you might, you might can appreciate that. I don't know.
[AGENT][POSITIVE] I get it, yes.
[CUSTOMER][NEUTRAL] Anyway, uh.
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, we have the, the cancer insurance, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so we had, uh, filed a claim. Um, he had been diagnosed with cancer and we received the one time, the $7500 on his thing. And then I was filing some other things. I filed one, he has prostate cancer, and so I had filed this stuff, the wellness claim for his PSA test. And then I had sent in, uh, we had talked with a lady here several weeks ago.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] And we were talking about all the other tests because he'd had an MRI he was having a PET scan and all the things. And so I had sent in what I had for the MRI and it just said it needed more. I can give you his information. I'm sorry, so you can look at his file. Do you need a
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, no, no, that is perfectly fine, um, so, no, no, you're right. It's gives me an idea of what we're looking for, uh, so we're essentially needing clarification on these claims and what further information is required.
[CUSTOMER][NEUTRAL] I just jumped right in.
[CUSTOMER][NEUTRAL] Yes, ma'am. And, and so his you know his policy number? His policy number is 0250 yes ma'am. 02525064.
[AGENT][NEUTRAL] Gotcha. OK.
[AGENT][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and what was his name, please?
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEUTRAL] OK, and is [PII] available that I can speak with him and verify his information?
[CUSTOMER][NEUTRAL] Um, he's not actually, he has ran into town. We're off today. He has a surgery scheduled tomorrow and we're trying to finish up some stuff. And so he's actually not here right now.
[AGENT][NEUTRAL] OK, I understand and I apologize um but as you are not listed as an authorized member um I would have to speak with him before I can disclose any uh information regarding claims so what I would recommend is either of course he can call or when he gets back you can call um I would.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Also recommend though if you're the one who's generally taking care of business uh is getting this um we have a third party authorization form that he can fill out with your information, get that to us and then we'll, you know, we wouldn't need him in the future if you were to call on your own and we could discuss everything with you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Is that on your website?
[AGENT][NEUTRAL] Yes ma'am, that is going to be on um it's just [PII] uh so it's different than the portal if y'all use that um it just doesn't have the secured in front of it so you'll see under um well I can actually go there so I can tell you what it is um under claims and forms at the very top right and it'll be close to the very first one it's the authorization to disclose information that's what that form is.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you could just get that to us however is easier for you um and then of course you know so I'm I'm sorry I can't help you over the phone right now though.
[CUSTOMER][NEUTRAL] OK, I'll look for that.
[CUSTOMER][NEUTRAL] Sure. Sure.
[CUSTOMER][NEUTRAL] No, that's OK. You, you might be able to answer this without disclosing anything. So this is kind of my question. So because the, um, the explanation that we got said the medical imaging benefit will pay the amount shown, uh, for someone who's been diagnosed and received either MRI, PET scan, and so on and so forth, but it says that you haven't received a pathology that you need a pathology report. Well, because the pathology report was sent um to get the initial.
[AGENT][NEUTRAL] Sure, of course.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Pay out. And so I didn't, I'm like.
[AGENT][POSITIVE] Uh, right, the um absolutely.
[CUSTOMER][NEUTRAL] And so I'm like, I didn't know. I was like, OK, so how do I filed that or then also my question, because he technically had the MRI prior to his diagnosis, they were still trying to figure out. And so is that a reason? Is the, the, the, the um the diagnosis date is after the MRI and so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Did you, you see what I'm saying?
[AGENT][NEUTRAL] Possibly, yeah, absolutely, um, so let me ask you this, [PII], um, I know you said that he had other wellness benefits as well were those also before the pathology report?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Or the the the initial day.
[CUSTOMER][NEUTRAL] Like for the
[CUSTOMER][NEUTRAL] Um, you're cutting out a little bit. The PET scan was done after.
[AGENT][NEUTRAL] Like if you had a uh 00, I'm sorry.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Oh, I'm sorry you're good. I said.
[CUSTOMER][NEUTRAL] They did the MRI. They did the MRI before he was diagnosed. He had it. He just, they were trying to, you know, go through all the steps and look before they did the cause they did the MRI before they even did the needle biopsy. Um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And then after that, then they did the PET scan to check for metastasis. Um, and so anyway, so I didn't know. I thought, well, it doesn't say anything on here about a date, you know, about the MRI being done prior to diagnosis. But, but I like, I was just wondering because like I said, the pathology report is technically on file. We sent it, but I just didn't know how to like link it to this too, because it only let me, cause it just let me upload the one thing with all. That's why I was confused.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Of course, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No yeah that is very confusing so the reason I ask about um another and when that was my guess and of course it does depend on this actual policy, most of the time under these policies it covers one diagnostic testing benefit per calendar year um and that's of course as a preventative uh measure so if there's additional coverage for um um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] Anything after it has been diagnosed, then my guess is that they took that one that had been filed before and took that as the one that he might have had already, uh, for the calendar year. Um, and so if this one could be covered, um, then of course, it would have been linked to that pathology report. So it could have just been a hiccup on our end and needs to be like, you know, yeah, here's the this is definitely because of the cancer. So.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Or this was before that so as the actual test, so yeah we can definitely get that taken care of as soon as you know we could either speak with [PII] or um get that form from you.
[CUSTOMER][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well I
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. OK. Yeah, he should be back in a little bit. I was just, um, he had ran into town and I was trying to get some stuff done. I thought, well, I'm gonna call before I forget, um, this, this morning. And the last time we called, we were both sitting here and so I didn't even think about that. Um.
[AGENT][POSITIVE] No worries.
[AGENT][POSITIVE] Of course, yeah, absolutely.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yes, well, and yeah, the phone calls are generally good for that phone call so you know if he says yeah you can speak with her, that would just be the one for that duration of that call.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Sure. Oh yeah. And he had initiated the phone call the last time. I was just sitting here and so sometimes I ask the questions and, you know, I had other, you know, because we're, we're kind of a team, you know, his, our brains work together really good and so I'm looking at him and so I start talking to whoever it was on the phone. And so we were both, we were both talking and he said, you call him and I'm like, OK, so.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] It's generally easier I understand.
[AGENT][NEUTRAL] You know that's why we have this option to add an authorized users so that that wouldn't be, you know, some people either are not in a position to or they just don't even wanna mess with it.
[CUSTOMER][NEUTRAL] Men
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Mhm. He gets frustrated very easily.
[AGENT][NEUTRAL] I, yeah, I get it. And so sometimes you got to take the reins.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm mhm yes ma'am, I see the authors of the um.
[CUSTOMER][POSITIVE] Um, authorization to disclose. I see it right here. OK, well, we'll get that taken care of and then we'll call you back later and we'll see if we can't figure out what we need to do and how to get it filed. Y'all been super helpful and everything has been easy and we appreciate that. So, um, that's.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's it, yes ma'am.
[AGENT][POSITIVE] Yeah, sounds good.
[AGENT][POSITIVE] Absolutely that's what we like to hear.
[CUSTOMER][POSITIVE] That doesn't happen very often these days, and so, so we're, we're thankful for that.
[AGENT][POSITIVE] No, we sure can do our best. Absolutely. Anything we can do to help.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] All right. Well, thank you and we'll speak with you or somebody else later. Thank you so much. You too. bye-bye.
[AGENT][POSITIVE] All right. Well, I hope you have a great rest of your day.
[AGENT][POSITIVE] Yes ma'am. I appreciate it. Yes, ma'am. Bye bye.
[CUSTOMER][NEUTRAL] Hold on.