AccountId: 011433970860
ContactId: 3cc16a27-54dd-4abd-b82c-bcf7a920e7c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 695750 ms
Total Talk Time (AGENT): 298710 ms
Total Talk Time (CUSTOMER): 283234 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/3cc16a27-54dd-4abd-b82c-bcf7a920e7c0_20250422T15:15_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII].
[AGENT][POSITIVE] Yes, sir, Mr. [PII]. I'm good. How can I help you today?
[CUSTOMER][NEUTRAL] How are you doing this morning?
[CUSTOMER][NEUTRAL] Well, I've got, uh, I got a bill from, uh,
[CUSTOMER][NEUTRAL] Uh, uh, where, where's the name of it? It's Diagnostic Laboratories of Oklahoma. And they, they said you all, that APL denied, uh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] denied the claim because I was not uh covered on the date of the service and uh we've been, I've had APL for
[CUSTOMER][NEUTRAL] I don't know, 3 or 4 years.
[CUSTOMER][NEUTRAL] So, the, the, the lady.
[AGENT][NEUTRAL] OK, Mr. [PII], so you're wanting to join a claim with tonight, is that correct?
[CUSTOMER][NEUTRAL] Well, yeah, I mean, I guess I need to, uh, I'm trying to find out why, why they're saying I didn't have coverage on the date that these people tried to file.
[CUSTOMER][NEUTRAL] Uh, a claim, I guess.
[AGENT][NEUTRAL] OK, yes, sir. Well, I can take a look at that for you and try and help you with this. So first off, what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have your policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh yes, uh, the policy number, 204468-38.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So give me just a couple of moments to get your information pulled up, Mr. [PII], and then what I'll need to do is I have to verify several things with you first for security and then any information that is provided for you today would be a verification of
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] benefits and not a guarantee of payment. So let's do your policy number one more time because I may have misheard you because that was too many numbers, what I, what I heard. So, anyway.
[CUSTOMER][NEUTRAL] Uh, OK. It, it says, it says policy slash certification number is 002.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 44
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 68
[CUSTOMER][NEUTRAL] 38
[AGENT][NEUTRAL] 38
[AGENT][NEUTRAL] OK, yes, sir. All right.
[CUSTOMER][NEUTRAL] 38, yes.
[AGENT][POSITIVE] Thank you. One moment. OK.
[AGENT][NEUTRAL] All right. So first off, Mr. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the next thing to verify is gonna be your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then the [PII], that is the best contact number that we should have for you. Is that correct?
[CUSTOMER][NEUTRAL] Uh, [PII], yeah, the [PII].
[AGENT][NEUTRAL] Yes sir and then do you have any.
[AGENT][NEUTRAL] email Mr. [PII] because we do not have one on file for you.
[CUSTOMER][NEUTRAL] Do I have what?
[AGENT][NEUTRAL] An email address?
[CUSTOMER][NEUTRAL] Email
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] 1
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So the reason I'm adding that in here Mr. [PII], it said that you if you choose to you can set up your profile.
[AGENT][NEUTRAL] So in our portal that's called the online service and that will allow you to have access to your ID cards, your
[AGENT][NEUTRAL] Policy information, it will also allow you to have to file your own claim with us you can actually upload all of your information directly in.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] To that portal for us to review and I have a user I will be happy to email you that gives you the instructions on all of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, what is the data service that I'm looking for for you?
[CUSTOMER][NEUTRAL] 812 of 2024.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And again, what is the, who is the provider?
[CUSTOMER][NEUTRAL] It is uh diagnostic laboratories of Oklahoma.
[AGENT][NEUTRAL] So we let me look at one claim, so we did receive a claim.
[AGENT][NEUTRAL] From the amount of $267.82. That was the total bill amount on the claim.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And we did pay $11.61 to them on one of the codes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And the other code was the.
[CUSTOMER][NEUTRAL] Yeah, I got, I got, I got two different bills. One was that bill and then one was the same.
[CUSTOMER][NEUTRAL] Uh, different, um,
[CUSTOMER][NEUTRAL] The total was 26021 and it was on the same date.
[AGENT][NEUTRAL] OK, now I don't, we only have the one claim on file for you period on that data service and for and then one of the.
[CUSTOMER][NEUTRAL] And they
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Codes on that particular bill that we received. We didn't, there weren't any benefits for us to pay because it shows that the, your major medical coverage provided full benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So there were no benefits for payable for that procedure, but on the other code we did pay.
[AGENT][NEUTRAL] Uh, the 11, which was, you know, this.
[CUSTOMER][NEUTRAL] Right, 1161.
[AGENT][NEUTRAL] Policy helps with your co-pays, deductibles and co-insurance amounts. So we did pay for that, but that's the only claim we've ever even received for that data service.
[CUSTOMER][NEUTRAL] Really? Well, I, I just got off the phone with
[AGENT][NEUTRAL] Yes, so I don't know why they would.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do what?
[AGENT][NEUTRAL] Yes, sir. So I'm not sure why they told you that because we don't, we don't even have.
[CUSTOMER][NEUTRAL] What, huh, what's
[CUSTOMER][NEUTRAL] She said, she said that they sent one.
[AGENT][NEUTRAL] I'll put the one plane.
[CUSTOMER][NEUTRAL] Yeah, I, I don't know if it's me, it's probably me, I'm cut, cutting out, but, or you're cutting out, but, uh, she, the lady I talked to with diagnostic laboratory said that they filed the claim in September and said it wasn't covered and then uh sent a claim in on
[CUSTOMER][NEGATIVE] Uh, [PII] and never got a response.
[AGENT][NEUTRAL] OK, so I don't know what address they're sending it to, but we, you only have.
[AGENT][NEUTRAL] This one policy with us, we didn't receive any would admitted on those time periods that she gave you as the dates.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That they said that they submitted it.
[AGENT][NEUTRAL] Again, the only one and only claim that we've.
[AGENT][NEUTRAL] Day for them is the one that I just provided that information about.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All righty, will do, uh, do they, let me, I'm trying to find the.
[CUSTOMER][NEUTRAL] The uh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The, I mean, if they sent that one, then they should know the they give them the address to, to send it to, but uh I'll call them back and then.
[AGENT][NEUTRAL] Yes, and now the address, yeah, the address is on your.
[AGENT][NEUTRAL] ID card. It should be a [PII].
[CUSTOMER][NEUTRAL] On what?
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Your ID card.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] PO Box.
[CUSTOMER][NEUTRAL] Uh, oh yeah, [PII].
[AGENT][NEUTRAL] 248,950.
[CUSTOMER][NEUTRAL] I've got 248,950.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Yes, sir. That is the address that they mail claim to and put it to attention claims department. Yes, sir.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] I support.
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, just claims departments? OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Department.
[AGENT][NEUTRAL] And they will, yes, sir. And they will need to include a copy of your primary insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Explanation of benefits.
[AGENT][NEUTRAL] There's two separate bills for the 2, I'm sorry, that 8-12, 2024 data service.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, there's, there's the one that you told me the, the.
[AGENT][NEUTRAL] Yes, sir. So we can receive one.
[CUSTOMER][NEUTRAL] Just the one. OK. All righty. Well, I'll call them back and let them know and have them resubmit it.
[AGENT][NEUTRAL] OK, well, I'm just sorry I don't know where the fusion is, but if you have any other questions, Mr. [PII], you can call us back and then I'm gonna go ahead and email you that user guide in just a moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK dokey.
[AGENT][NEUTRAL] So then you'll be able to set it up. All right.
[CUSTOMER][POSITIVE] Alrighty I thank you.
[AGENT][POSITIVE] Well, you're very welcome. So it's all I can help you. Thank you for calling.
[CUSTOMER][POSITIVE] You have a wonderful rest of your day.
[AGENT][POSITIVE] Oh, thank you. I hope you do too, Mr. [PII] and. Thank you.
[CUSTOMER][POSITIVE] Oh, thank you.
[AGENT][NEUTRAL] Again for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye. Yes, sir.
[AGENT][NEUTRAL] A bath.
[CUSTOMER][NEUTRAL] Bye.