AccountId: 011433970860
ContactId: d5d907d4-518a-426c-abe4-ff6b5bfa013e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377380 ms
Total Talk Time (AGENT): 153862 ms
Total Talk Time (CUSTOMER): 151320 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/d5d907d4-518a-426c-abe4-ff6b5bfa013e_20250211T20:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I was calling to see if one of my, or if you guys had processed any claims that have been submitted to you from DLO.
[AGENT][NEUTRAL] I can check and see if we received the claim and you said it's from TLA.
[CUSTOMER][NEUTRAL] From DLO.
[CUSTOMER][NEUTRAL] Diagnostic Laboratories of Oklahoma.
[AGENT][NEUTRAL] OK, thank you. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] ER [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02515497.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[AGENT][NEUTRAL] OK, for security, may I have your date of birth, mailing address and email address on file.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] And probably [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, OK, let me check the claim history. OK, one moment.
[AGENT][NEUTRAL] OK, the only claim we have received in process is the one for Madridge Orthopedic Hospital. Um, this is the only one we have received as of today.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, any ideas what I'm supposed to do? because I called DLO like I think I submitted, had them reprocess and resubmit to you guys um back in November, I believe it was and they said to allow at least 30 days for that to process, um, but it's been since December.
[CUSTOMER][NEUTRAL] November now and I guess you guys still haven't got anything from them so I'm not really sure what to do next um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I'm, I'm waiting. I don't wanna do more blood tests until
[CUSTOMER][NEGATIVE] Like those last two go through and you guys still haven't gotten them from them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm not really sure what my next step is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so right now there are two options. Um, either you can call them again, see if they can send it one more time, um just verify the mailing address that make sure that it's matching the one on the card or the fax number that is matching the one on the card, which it should be the one in [PII]. Um.
[AGENT][NEUTRAL] And also, um, or you can just have them to send you the paperwork so you can submit your own claim. Now, if they're gonna send you the paperwork, we need 3 documents. Um one is coming from them, but the other one is coming from the primary insurance and then one is gonna be the claim form. So we need the 3 documents, a claim form that you can find on our website at [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The itemized bill, which it will come from the provider of service and it has to have the diagnosis code.
[AGENT][NEUTRAL] And the copy of the explanation of benefits from the primary insurance showing how much they apply towards the deductible co-payment and co-insurance.
[AGENT][NEUTRAL] Hello Miss [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, I'm writing this down so I need the itemized bill with the diagnostic codes from the provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then explanations of benefits from the insurance company that explains the co-payments. Oh, from, yeah, primary insurance.
[AGENT][NEUTRAL] From the primary.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And then what was the 3rd thing that I need?
[AGENT][NEUTRAL] The claim form.
[CUSTOMER][NEUTRAL] Where do I get that from your website?
[AGENT][NEUTRAL] From our website, mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that's if you're gonna submit the claim, um, the easiest way is to have them submit it again, um, just verify the information just to make sure they're sending it to the correct place, um, and see if they can send it for you. That will be the easiest way, but if they can, yeah, you need to send us the claim so we can process as soon as possible, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then the address that they would send it to is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or the fax is [PII].
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] OK. All right. Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, thank you for calling APL. You have a good day, Miss [PII].
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] You're welcome. Thank you.