AccountId: 011433970860
ContactId: 1ed66be4-5ed4-4598-880b-518cf7d069e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1548890 ms
Total Talk Time (AGENT): 446973 ms
Total Talk Time (CUSTOMER): 441575 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/1ed66be4-5ed4-4598-880b-518cf7d069e2_20250218T20:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Um, I have been trying to get a bill, um, sent to the correct.
[CUSTOMER][NEUTRAL] Um, place, um, because it's kind of like been in limbo but back and forth. I've been playing middleman between the lab and um 90 degree benefits and one's claiming they sent and one claims that it was rejected and but it was also not, it's like a back and forth, um, and I just got off the phone with 90 Degree and I think I have.
[CUSTOMER][NEUTRAL] A potential answers to why, and I think it's because they, from they said from the clearing house that it was sent to American public life, uh, probably, and because the um
[CUSTOMER][NEUTRAL] The lab gave me a reason that it was because they said there was a misinformation that the the group number and the ID number did not match so they could not identify the patient, which is why they had been like rejecting it essentially. Um, so 90 Degree just forwarded me to you to make sure that um because they said that like sometimes like this happens like some things get sent to the wrong place and then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, if things don't match up, so I'm calling now to um see if something was sent over and uh she, the, the agent from 90 Degree benefits mentioned that um if they could get.
[CUSTOMER][NEUTRAL] The information faxed to them so that they could take care of the claim if
[CUSTOMER][NEUTRAL] If it was, that was kind of the case.
[AGENT][NEUTRAL] OK, alright [PII] is the claim for yourself or is it for a patient?
[CUSTOMER][NEUTRAL] It's for myself. I'm, I'm the patient.
[AGENT][NEUTRAL] OK, and what is your um callback number, sir, our call is disconnected.
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and can you please give me your policy number?
[CUSTOMER][NEUTRAL] Yes, let me, uh, pull the card up. I just put it away. Um, policy number with
[CUSTOMER][NEUTRAL] Um, I currently only have what I have for the provider for 90 Degree. Is that gonna be sufficient?
[AGENT][NEUTRAL] OK. Um, does it start with a D?
[CUSTOMER][NEUTRAL] Yes, my employee ID number, yes.
[AGENT][NEUTRAL] OK, can you, right, can you give me your social security number so we can pull in your APM policy?
[CUSTOMER][NEUTRAL] Yes, the number is, let me turn off my hotspot here. I think that's why this is, this call is kind of breaking up just a little bit. Let me just turn this off.
[CUSTOMER][NEUTRAL] OK, my number is [PII].
[CUSTOMER][NEUTRAL] 363-586
[AGENT][NEUTRAL] Let me look that up real quick.
[AGENT][NEUTRAL] OK, and did you file this on your hospital indemnity plan?
[CUSTOMER][NEUTRAL] Uh, I did not have a, to my knowledge, I didn't have a hospital inde indemnity plan.
[AGENT][NEUTRAL] OK, is it a medical it's a lab claim for medical or is it for an accident claim?
[CUSTOMER][NEUTRAL] It was a preventative service.
[AGENT][NEUTRAL] OK, so that would be your hospital indemnity. Um, let me go ahead and pull that up. Can you please verify your date of birth for me, [PII]?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] And then also for security reasons I'm gonna need you to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Yes, my address is [PII].
[CUSTOMER][NEUTRAL] My email address is my first name, middle initial, last name, which is [PII] [PII].
[CUSTOMER][NEUTRAL] And I'm sorry, I'm not sure what else you need me to verify.
[AGENT][NEUTRAL] Uh, the number you gave me to call you back on if we're disconnected, is that your cell phone number?
[CUSTOMER][NEUTRAL] Yes, [PII], yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you so much. Let me give you your APL policy number so you have that on hand.
[CUSTOMER][POSITIVE] OK, dokey. I'm ready.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] 247.
[AGENT][NEUTRAL] 6144.
[CUSTOMER][NEUTRAL] 247-6144, got it.
[AGENT][NEUTRAL] Yes, sir. And um do you remember the date of service from the lab?
[AGENT][NEUTRAL] That you had what day you went in.
[CUSTOMER][NEUTRAL] Yes, it, it was.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do find a claim for um.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, that was paid $150.
[AGENT][NEUTRAL] And the check number is 2014381. It was paid to the provider.
[AGENT][NEUTRAL] Let me look and see if the check is cleared or not.
[AGENT][NEUTRAL] Give me just a sec.
[AGENT][NEUTRAL] Yes, they cleared the check on [PII].
[CUSTOMER][NEUTRAL] And you said that was paid to the providers that was paid to 90 degree benefits?
[AGENT][NEUTRAL] No, it was paid to uh Doctor [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you get that check number?
[CUSTOMER][NEUTRAL] The check number is 2014381.
[AGENT][POSITIVE] Yes, yes, sir, that's correct.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] That it that they cashed it was [PII].
[CUSTOMER][NEUTRAL] Yeah, and that was that was cash number 27.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, would you like the claim number also?
[CUSTOMER][NEUTRAL] Yeah, I'll go ahead and take the claim number.
[AGENT][NEUTRAL] OK, that's 352.
[AGENT][NEUTRAL] 3730.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that maybe that'll help you knowing that we paid we paid the claim of $150.
[CUSTOMER][NEUTRAL] OK, interesting, so.
[CUSTOMER][NEUTRAL] I guess I'm confused as to how the lab, why the lab says that it was kicked back because the group ID number, uh, the group number and the ID number weren't valid.
[AGENT][NEUTRAL] OK, let me give you the group number that's on this policy.
[AGENT][NEUTRAL] It is 70,030.
[AGENT][NEUTRAL] And that is Creative Circle LLC.
[CUSTOMER][NEUTRAL] OK, so the group number that I have is different on my card. I have just 9412, but I'm assuming, and that's also through Creative circle. Your, your group number you said is, I'm sorry, can you repeat that one last time for my notes?
[AGENT][NEUTRAL] Yes, it's 70,030.
[AGENT][NEUTRAL] And that's through APL for Creative Circle LLC.
[CUSTOMER][NEUTRAL] 70,030 through who?
[AGENT][NEUTRAL] APL that's um.
[CUSTOMER][NEUTRAL] 00, through APL sorry, so yeah, my bad.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, um, interesting, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I'm, I guess I'm confused on next steps, um.
[AGENT][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Uh, like I said, I've been playing Middleman, um, kind of back and forth.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I understand.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Yeah, so if they say that the group number and the.
[CUSTOMER][NEUTRAL] The group number and the ID.
[CUSTOMER][NEGATIVE] Aren't consistent for some reason and that they're unable to identify patient. Um, but then 90 Degree says they paid and then you say you paid, but then um
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I'm super confused as to
[CUSTOMER][NEUTRAL] Um, who has the incorrect.
[CUSTOMER][NEUTRAL] Information. I guess I can go back to the lab with this new group number and see if that changes anything.
[AGENT][NEUTRAL] Yes, that's the um that's the um group number for us for APL and that would be correct the whole group has that number here with our company.
[AGENT][NEUTRAL] And also if you let them know that we paid $150 and give them the check number and the date that it cleared the bank, that may help you also.
[AGENT][NEUTRAL] Now, I do show that um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Procedure, I'll give you this procedure code.
[AGENT][NEUTRAL] 3008 F as in Frank.
[AGENT][POSITIVE] Has a remark and that remark says.
[AGENT][NEUTRAL] The charges submitted are not covered by the policy contract so it was a non-covered service.
[AGENT][NEUTRAL] Whatever that procedure code is.
[AGENT][NEUTRAL] Which I don't, I'm not in the claims department, yeah, there was one thing that was not covered, um.
[CUSTOMER][NEUTRAL] OK, so something wasn't uh.
[AGENT][NEUTRAL] And that was that procedure code that I gave you.
[CUSTOMER][NEUTRAL] OK. And can you repeat that number for me?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] You said it's a procedure code?
[AGENT][NEUTRAL] Yes, the procedure code is 3008 F as in Frank.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And that was not covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and let me look here real quick 201438-0. 1 more thing I wanna look at.
[AGENT][NEGATIVE] OK, you should have received a check for $24.
[AGENT][NEUTRAL] And it went to [PII].
[AGENT][NEUTRAL] Zip code [PII].
[AGENT][NEUTRAL] In the amount of $24 you should have received a check in that amount and the check number is 201.
[AGENT][NEUTRAL] 4380.
[AGENT][NEUTRAL] And I'm showing the check is still outstanding and it was issued on [PII].
[CUSTOMER][NEGATIVE] Well, I do not think I received that.
[CUSTOMER][NEUTRAL] Um, maybe I got lost in the mail.
[AGENT][NEUTRAL] OK, while we're on.
[AGENT][NEUTRAL] Yes, sir, while we're I'm on the phone with you, I'm gonna put a request in to void that check and reissue a new one for you.
[AGENT][NEUTRAL] It's gonna be just a brief hold while I get that request in um to the claims department if you don't mind holding for a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII] I've got that um request in to void that check out and issue a new one.
[AGENT][NEUTRAL] [PII], are you there?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hello, sir. Are you there?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] No, no worries. No worries. OK. Well, thank you so much. I'll follow up with you in a second if you don't mind. Thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, hello.
[AGENT][NEUTRAL] Hi, this is [PII] back with you again. I've got um that request in now to void that check and reissue a new one for you.
[CUSTOMER][NEUTRAL] Are you there?
[CUSTOMER][POSITIVE] OK wonderful thank you um.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I, I also have my explanation of benefits that 90 degree scent, um, so I'm also looking at that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um what would your recommendation be for next steps? Would it be to contact the lab, send them the explanation of benefits that they requested, and then look for, I guess, um, I know I got some paper.
[CUSTOMER][NEUTRAL] Um, APL documentation from, I believe is also an explanation of benefits.
[CUSTOMER][NEUTRAL] Um, would you be able to send me the APL?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Version of that so I can have both and just an electronic copy for quick viewing.
[AGENT][NEUTRAL] Yes, I can send it. Do you have a fax number I can send it to?
[CUSTOMER][NEUTRAL] Um, I don't have a fax number. I was hoping you could send it via email. Is [PII]hat possible?
[AGENT][NEUTRAL] Uh yes sir, let me, um.
[AGENT][NEUTRAL] Let me pull it up real quick. It's gonna be just a moment so I can pull pull in the EOB for you.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I can see.
[AGENT][NEUTRAL] I have to find the right 12, OK.
[AGENT][POSITIVE] Of course, everything is deciding to be slow while I'm on the phone with somebody and when you're not on the phone, everything works just lickety fast.
[CUSTOMER][POSITIVE] For sure.
[AGENT][NEUTRAL] OK, let me get
[AGENT][NEUTRAL] This I do see it. I'm gonna put it in there for mail recipient for you. Let me pull up your email address.
[AGENT][POSITIVE] I appreciate you being patient while my computer works its thing.
[CUSTOMER][POSITIVE] Oh, no worries. I've been on hold for a total of like forever today, so, trust me, it it is fine.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] It seems to be a really busy time.
[AGENT][POSITIVE] Yes sir it is.
[AGENT][NEUTRAL] And let me put that claim number in here so you have it.
[AGENT][NEUTRAL] OK, I just sent it.
[AGENT][NEUTRAL] To you so you have it.
[CUSTOMER][POSITIVE] Excellent. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you get through this?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think I have next steps. Luckily they put the bill on hold for me, so it's not gonna like.
[CUSTOMER][NEGATIVE] Um, get sent anywhere, um, undesirable, but
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Curious because of my group number on my member card is different from the APL one that you've told me, um.
[CUSTOMER][NEUTRAL] Uh, I'm curious if
[CUSTOMER][NEUTRAL] Because they sent it to 90 degree benefits and it got kicked back.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And so I'm curious that it needed to be sent to APL instead.
[CUSTOMER][NEUTRAL] Or it did get sent to APL and it used my group number that I have which is 9412.
[CUSTOMER][NEUTRAL] And it didn't recognize it because my APL group number is a different number.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] That's what I'm curious.
[AGENT][NEUTRAL] The process worked because it got paid, so it looks like they sent it to uh 90 Degree.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Benefits and the 90 degree benefits send us our part.
[AGENT][NEUTRAL] And it got paid, so that's what I think happened because on your card doesn't it say to mail the claims to 90 degree benefits that doesn't say to mail it to APL.
[AGENT][NEUTRAL] Or does it?
[CUSTOMER][NEGATIVE] Correct, it just says, um, it just says 90 degree benefits. APL is not even anywhere on the card actually.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, so 90 degree benefits, um.
[AGENT][NEUTRAL] When they get the claims?
[AGENT][NEUTRAL] If it's not their portion to pay, they send it to us. So the process should work.
[AGENT][NEUTRAL] But if you want to give them that other information, give them their, your policy number and your group number, you can do that. Let them know that we work together with 90 degree benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I guess I'll I'll send them all this information and see if that clears anything up, um.
[CUSTOMER][NEUTRAL] Like hopefully, um, because now that I know it has been paid on the on both sides, it's, I'm said sounds like it's just quest diagnostics, it's not.
[CUSTOMER][NEUTRAL] Something's off there, I think is what's happening.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, uh, thank you. That's awesome. I got a lot more information now to go off of and um.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Hopefully this works. So thank you very much.
[AGENT][POSITIVE] Yes, sir. Well, I wish you the best of luck with them.
[CUSTOMER][POSITIVE] I appreciate that.
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're very welcome. You have a blessed rest of your day and thanks for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] Bye.