AccountId: 011433970860
ContactId: 8810939c-ab07-4641-84f0-fce49d3d89a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1088000 ms
Total Talk Time (AGENT): 307687 ms
Total Talk Time (CUSTOMER): 446332 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/8810939c-ab07-4641-84f0-fce49d3d89a9_20250211T18:00_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] How I put.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling you from DJO LLC provider's office for checking on a claim status.
[AGENT][POSITIVE] Uh, sure, I can assist you with claim status.
[AGENT][NEUTRAL] And um may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and I'm sorry, can you repeat your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how many claims do you have?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, firstly, I would like to check the status of the one claim and then I'll let you know.
[AGENT][NEUTRAL] OK, uh, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] OK, uh, let me have the policy number, Miss [PII].
[CUSTOMER][NEUTRAL] Please wait a moment
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the policy number is 2353095.
[AGENT][NEUTRAL] 325. I'm sorry, I didn't get that.
[CUSTOMER][NEUTRAL] 2353095
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The first name is [PII], that is [PII] and the last name is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the date of birth of the patient is [PII], that is [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim, Ms. [PII]?
[CUSTOMER][NEUTRAL] Can you please say it again?
[AGENT][NEUTRAL] A of service in amount of the claim.
[CUSTOMER][NEUTRAL] OK, please wait a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of service is [PII]. That is 11-2624. And the bill amount for the
[CUSTOMER][NEUTRAL] Claim is $335.04.
[AGENT][NEUTRAL] I'm sorry, you got cut off. That was 3:35 and how many cents?
[CUSTOMER][NEUTRAL] 4 cents
[AGENT][NEUTRAL] 4 cents, OK.
[AGENT][NEUTRAL] Thank you, let me see if I can find this claim for you and for the future, you can check the status online through our website at [PII].
[CUSTOMER][NEUTRAL] Can you please send me the website?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you please spell it out?
[AGENT][POSITIVE] [PII]
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Mhm, correct, yes, [PII].
[CUSTOMER][NEUTRAL] OK, can you please provide me the claim status for this?
[AGENT][NEUTRAL] Yeah, I'm looking for your claim. One moment.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Ma
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] every day
[AGENT][NEUTRAL] OK, we've recently received this claim today, but it is missing the explanation of benefits from the primary insurance.
[AGENT][NEUTRAL] So the claim is in line to be processed, but it's missing the EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] OK OK
[CUSTOMER][NEUTRAL] the primary your bill is missing and the claim is in process, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim is in line to be processed. It was received today.
[CUSTOMER][NEUTRAL] The received date of the claim.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Today?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please wait
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The claim is received today and the primary EOB is missing.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the primary year
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can you please guide me how to send the primary?
[AGENT][NEUTRAL] You can fax it or mail it.
[CUSTOMER][NEUTRAL] OK. May I get the fax uh fax number?
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I'll repeat it. [PII]. Is it correct?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, can you please send me the mailing address?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the mailing address is [PII].
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One minute.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] I'm sorry, let me go back.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Is it the complete mailing address?
[AGENT][NEUTRAL] Yes. Do you, do you need me to repeat it again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you please check it once, like it is [PII] [PII].
[AGENT][NEUTRAL] Yes, that's correct, and it's [PII].
[CUSTOMER][NEUTRAL] CD is also [PII].
[AGENT][NEUTRAL] Yeah, [PII], [PII].
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Can you please provide me the call reference number or either you'll be changing the call reference number in my name or you'll be giving the.
[AGENT][NEUTRAL] We don't, we don't have we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Uh, can you please spell out your name?
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And after this,
[AGENT][NEUTRAL] [PII] is the last initial.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] The last name initial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you please be on hold for one minute?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can you please provide me the another claim status?
[AGENT][NEUTRAL] Sure. Um, is it a different member?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Uh, please wait a moment
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll be providing you the details.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] The member ID for the patient is [PII] [PII].
[AGENT][NEUTRAL] OK. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK, please wait a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of birth is [PII]. That is [PII], and the last name of the patient is [PII], and the first name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, can you please repeat it again?
[AGENT][NEUTRAL] Date of service and amount of the claim.
[CUSTOMER][NEUTRAL] Yeah, for this, OK.
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII]. That is [PII].
[CUSTOMER][NEUTRAL] [PII] and the bill amount for the patient is $335.04.
[AGENT][NEUTRAL] OK, one moment, let me see if I find this one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And you said the total charge was 33504?
[CUSTOMER][NEUTRAL] Yes, $335.04.
[AGENT][NEUTRAL] I don't have one for that amount. Do you want to check the amount just to make sure that it's the correct amount?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please let me know the bill amount?
[AGENT][NEUTRAL] No, we cannot give you the bill amount. I need to know what amount you have because it's not matching.
[CUSTOMER][NEUTRAL] 21.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I should say that be someone right.
[CUSTOMER][NEUTRAL] Yeah the mountain.
[CUSTOMER][NEUTRAL] It's it called a balance.
[CUSTOMER][NEUTRAL] Is it $161.95?
[AGENT][NEUTRAL] No. Mm mm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] No, that's not the amount we have. Um, so that means that we don't have that claim. We don't have a claim for that amount.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can you please check with the first name and the last name?
[AGENT][NEUTRAL] No, I have the member pulled up. I have all the information of the member pulled up. I have a date of service of [PII], but I don't have a claim for $335.04 so it's gonna be not on file if that's not the amount. If that's the amount of 33504, we don't have that one on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And no claim on for go drink.
[CUSTOMER][NEUTRAL] I is it?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please send me the patient eligibility?
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK, we have an effective date of [PII].
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And it is active at the.
[CUSTOMER][NEUTRAL] [PII] is the effective date.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Active at the moment?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] This is the effective date and it is, he is active.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] there is
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, can you please provide me the mailing address?
[AGENT][NEUTRAL] It's gonna be the same one as I gave you prior, which is the [PII].
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Can you be providing me the previous uh claim claim number?
[CUSTOMER][NEUTRAL] For the patient.
[CUSTOMER][NEUTRAL] Uh, I'll let you know.
[AGENT][NEUTRAL] What previous
[CUSTOMER][NEUTRAL] The previous claim which I have taken this on this call, I need the claim number for that patient.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, we will have to go back to that one because I already finalized that one. right now we're right now under Brian settlement, so let's finish this one and we can go back once we finish this one, but, um, do you need any other information on this one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I don't need any other information on this claim. I have another claim too, but uh if you provide me the claim number of the previous one, I'll be moving forward.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me. I, I need to finalize the note and then I need to go back to the previous one and then we can get that information back, OK, because I already got out of that account, so bear with me just a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][NEUTRAL] Can I take any information.
[CUSTOMER][NEUTRAL] Hmm, ma'am, mailing address, the patient eligibility on a claim or claim status.
[CUSTOMER][NEUTRAL] Uh, status or a claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and give me the, the previous policy number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, please wait a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The previous policy number is 2353095.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, for this one, there was not a claim number because it was just received today, so it has not been processed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You get
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Will you be assisting me with another?
[AGENT][NEUTRAL] OK. What is the next policy?
[CUSTOMER][NEUTRAL] Clean
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Wait a moment
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][POSITIVE] Uh, that's all, thank you. I don't have another one. Thank you for assisting me for today.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day, Miss [PII].
[CUSTOMER][POSITIVE] Thank you. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I