AccountId: 011433970860
ContactId: 25971d7c-e7e8-4142-9ca6-84502a6093f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 874169 ms
Total Talk Time (AGENT): 235630 ms
Total Talk Time (CUSTOMER): 360442 ms
Interruptions: 7
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/25971d7c-e7e8-4142-9ca6-84502a6093f8_20250602T14:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling you from McCloud Regional Medical Center. I'm calling to check the status of this claim. I faxed it, and I was just wondering if you guys have uh the claim on file.
[AGENT][NEUTRAL] OK, I can help you with that claim, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, um, my callback number is [PII] and your name is?
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And um what's the policy number that you are submitting a claim for?
[CUSTOMER][NEUTRAL] Uh, policy number is DS David 43732118.
[AGENT][NEUTRAL] Do you see a policy certificate number on there?
[CUSTOMER][NEUTRAL] Policy certificate number.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Um, let me see the.
[CUSTOMER][NEUTRAL] I only have the ID card, but the insurance ID card.
[AGENT][NEUTRAL] OK, and it doesn't say policy certificate number in.
[CUSTOMER][NEUTRAL] Is that what you need? The group number?
[AGENT][NEUTRAL] Uh, it would say policy certificate number or inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Post.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, it just says MAU Workforce Solutions, has a group number, uh, medical coverage, uh, does not say.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] No, it only says 90 degree benefits and the phone number to call, which I did call.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, um, and did you, can I verify the address that you sent it to?
[CUSTOMER][NEUTRAL] Do you need probably the patient's name?
[CUSTOMER][NEUTRAL] Yes, um, [PII] again [PII] and I also faxed it. I faxed it to the number that it was provided. Um, fax number was [PII].
[AGENT][NEUTRAL] OK, yeah, cause that is 90 degrees. Um, do you have
[AGENT][NEUTRAL] What's their last name and I can look it up and see if we have it.
[CUSTOMER][NEUTRAL] Um yes. Um his last name is [PII] um and first name is [PII]
[AGENT][NEUTRAL] Give me just a moment. Um, can you spell that first name one more time? [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh huh. [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Give me just a moment, let me see if I can pull them up.
[AGENT][NEUTRAL] And can I get you to verify his name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] One of these, oh, it's good.
[AGENT][NEUTRAL] And what was the date of service of the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, let me see if I can find it.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you happen to know if you filed it under hospital indemnity or not?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I, I faxed it, well, because the patient came to the emergency room. He came to the hospital.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And do you know what the total bill amount was?
[CUSTOMER][NEUTRAL] Yes, uh, the toma bill was for $1,719 even.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, it looks like we received this claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Let me see what.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment. It looks like it was submitted differently, so give me just a moment.
[AGENT][NEUTRAL] OK, I'm sorry, it looks like that claim was submitted on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] And it looks like we paid $75 towards that claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. What kind of plan um is this um because we have, it seems like we have um
[CUSTOMER][NEUTRAL] American Public Life, and then we have 90 Degrees. Is it the same company?
[AGENT][NEUTRAL] It's the same company but for 90 degree benefits they go through IMA first and then they come to us um and it looks like they did that.
[AGENT][NEUTRAL] Um, but you submitted through IMA first, which you did correctly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so it does look like that we paid, oh go ahead.
[CUSTOMER][NEUTRAL] Because we have.
[CUSTOMER][NEUTRAL] No, no, I'm just saying because that's, I was, that's why I was kind of confused because we did got the payment of $75.
[CUSTOMER][NEUTRAL] But it was paid by um APL, American Public Life, and it was $75.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And that payment was received on [PII], [PII], uh-huh.
[AGENT][NEUTRAL] Yes, so it does go through, uh, um, you do send it to IMA first and then um they approve it and send it to us and we pay it.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] For those 90 only for the 90 degree ones.
[CUSTOMER][NEUTRAL] OK, so that payment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the, the 75 payment then is from you guys?
[AGENT][NEUTRAL] Yes, ma'am. Right. And we paid $75 because with that check, the maximum benefit payable had been met.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] That's why we pay the $75 instead of the whole, mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm, OK, one second, Max.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Maximum, um, and, uh, what you say maximum what?
[AGENT][NEUTRAL] The maximum benefit payable for that date of service has been met.
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] So, um, so the American, um, the American, I'm sorry, hold on one second. The
[CUSTOMER][NEUTRAL] American public life is is not considered a secondary insurance, right?
[AGENT][NEUTRAL] Um, we're not major medical.
[AGENT][NEUTRAL] So if they do have a primary you you'd go through the primary first but yes you can this is.
[AGENT][NEUTRAL] If this is the only one that he has.
[AGENT][NEUTRAL] And it would be considered the primary, but we're not major medical.
[CUSTOMER][NEUTRAL] OK, OK, so yeah, it's because it's very confusing, yeah, because like we got the payment from um.
[AGENT][POSITIVE] I know, I, I apologize.
[CUSTOMER][NEUTRAL] Yeah, American public. The American public process the payment and then you guys make the payment.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The patient does not have it. And um let me see if I have a EOB on file um for this one. And the rest, and because it's maximum allowable, the rest is patient's responsibility, right?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, so you don't know if, if anything was applied to patient secondary insurance?
[AGENT][NEUTRAL] No, I would not be able to check on that. You'd have to call their secondary.
[CUSTOMER][NEUTRAL] Uh, who, who will be the secondary because uh, I'm um I thought that.
[CUSTOMER][NEUTRAL] Um, American Public was their secondary insurance and for some reason, we were about to refund the $75 which was the one that it was.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Processed by you guys.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] They might not have secondary insurance.
[CUSTOMER][NEGATIVE] So who could tell me um how the claim was paid because it doesn't, it doesn't give me um on the EOB that I'm looking, it doesn't say what line items were paid.
[AGENT][NEUTRAL] They
[CUSTOMER][NEUTRAL] Um, uh.
[AGENT][NEUTRAL] Um, it looks like for this one, he doesn't have a major medical and so you would build this one first. If he had a secondary and he gave you all secondary insurance, um, I, I'm not able to see that.
[CUSTOMER][NEUTRAL] Yeah, he just gave us the American Public life and then the um 90 degree.
[AGENT][NEUTRAL] Just, just this one, OK.
[CUSTOMER][NEUTRAL] Which, which for us, we thought it was.
[AGENT][NEUTRAL] Which is through us.
[CUSTOMER][NEUTRAL] Yeah, that it was 90 degree benefits was a primary and the American public life is a secondary.
[AGENT][NEUTRAL] Oh, no, ma'am. They, they are the same. They get 90 degree benefits through us. Yeah. So if he doesn't have another insurance, this is, this would be the primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But he does not have any major medical.
[AGENT][NEUTRAL] That I can see that would be what he gives you.
[CUSTOMER][NEUTRAL] OK. So, uh, oh, OK.
[CUSTOMER][NEUTRAL] OK, and if I wanna check like how the claim was paid, um, I will call American um public to, to, to, um.
[AGENT][NEUTRAL] For claim status?
[CUSTOMER][NEUTRAL] To explain, yeah, to see how the claim was paid, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Correct, yeah, you just submit the claim through IMA and then we we handle the rest.
[CUSTOMER][NEUTRAL] OK. OK. OK. Mm.
[AGENT][NEUTRAL] Um, if there's issues with the claim, then we'll transfer you, but typically you just send the, the claim to IMA for this one, and then, uh, we process it after they approve it.
[AGENT][NEUTRAL] But when you, but when you call for claim status we can help you with that, mhm.
[CUSTOMER][NEUTRAL] Yeah, because APL is that
[CUSTOMER][NEUTRAL] OK. And can you provide me the claim number that is under this one?
[AGENT][NEUTRAL] Yes, ma'am. It's 35.
[AGENT][NEUTRAL] 852-220.
[CUSTOMER][POSITIVE] OK, got it. OK, thank you.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that will be it [PII]. Thank you.
[AGENT][POSITIVE] OK. Thank you so much for calling [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] OK.