AccountId: 011433970860
ContactId: 5dec186b-cb3a-4cd1-a5d1-3af93a1a7e6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754479 ms
Total Talk Time (AGENT): 259529 ms
Total Talk Time (CUSTOMER): 321227 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/5dec186b-cb3a-4cd1-a5d1-3af93a1a7e6f_20250409T20:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling because, um, I called earlier today, um, and my OBGYN had called you guys about my, my insurance and that you guys weren't able to cover it, but then
[CUSTOMER][POSITIVE] I reached back out to you guys and you guys have like 90 degree benefits covers any sort of like OBGYN um things under like wellness.
[CUSTOMER][NEUTRAL] And I'm just trying to think and then I, I went to my I went to the
[CUSTOMER][NEGATIVE] The doctor's office and they were told that I don't have medical coverage, so they weren't going to cover my
[CUSTOMER][NEUTRAL] Just annual OBGYN so I'm just getting confused on like if I have it or not.
[AGENT][NEUTRAL] OK, um, let's see, do you have your social?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, I can give you my social.
[CUSTOMER][NEUTRAL] Or I haven't had to get my social before. Is that normal?
[AGENT][NEUTRAL] Well, you can give me your last name. It's just, uh, if you're with 90 Degree, the policy number usually I can't pull it up. I have to pull it up by your name or your social.
[CUSTOMER][NEUTRAL] Uh, yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I, I show you have several policies here, um, a dental policy, group term life, critical illness, group accident, and a hospital committee.
[AGENT][NEUTRAL] Um, so are you, are you going for like a well woman exam or the 6th visit or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's a well yeah it's a well just like the standard well woman exam, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me get this pulled up real quick.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, because so we're APL and we do like the supplemental policies for your group.
[AGENT][NEUTRAL] Um, IMA is the major medical portion.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, who is it? Who, who is it?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] IMA I think you had spoke with uh [PII] earlier and she gave you the number for IMA.
[CUSTOMER][NEUTRAL] It's only gonna be a 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but we, we do the supplemental.
[CUSTOMER][NEUTRAL] So I have to call that. Mhm.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK, I, I.
[CUSTOMER][NEGATIVE] I think I'm just having a hard time understanding the difference. I, I, I'm just not well versed in this stuff, so.
[CUSTOMER][NEUTRAL] You, when you say supplemental, what do you, what is that providing? I think I'm just walking.
[AGENT][NEUTRAL] OK, so, so through us, you have a dental policy.
[AGENT][NEUTRAL] Um, you have like a critical illness, and that's, it's a supplemental policy, so it'll only pay for very specific things. It's not like a major medical where like Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, yeah, I I under I understand that so but so you guys.
[CUSTOMER][NEUTRAL] Pay for like my physical.
[CUSTOMER][NEUTRAL] You guys covered my physical, I believe, and is that or is that not what you guys covered?
[AGENT][NEUTRAL] Let me see if that's covered under one of these policies.
[CUSTOMER][NEUTRAL] that many.
[AGENT][NEUTRAL] Hold on one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm pulling it up, just give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. Um, OK, so, for example, yes, so your hospital indemnity plan, this is a supplemental policy, you have a benefit where it will pay you, it pays you $75 if you get a wellness exam.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that that's, that's what it will pay you for getting a wellness exam.
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] Now, you would want, if you have major medical, you want to file it through that because it'll, it should pay in full on your major medical plan, but through this plan, it'll also pay you $75 for getting that wellness exam.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And when you say wellness like.
[CUSTOMER][NEUTRAL] Women's wellness.
[AGENT][NEUTRAL] Yes, yeah, a routine um exam, yes.
[CUSTOMER][NEUTRAL] OK, so then, OK, so I guess I'm confused as to why they called and they were told that it wasn't covered and I did give them that number that you guys gave me I think because you said IMA. I gave them that number they spoke to them and then they said.
[CUSTOMER][NEGATIVE] That they don't, they don't offer that.
[CUSTOMER][NEUTRAL] Or they just told my and and maybe it's an out of network situation but at at least uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, um, when I looked and maybe maybe I just looked in the wrong place that my.
[CUSTOMER][NEUTRAL] OBGYN was under providers, but I may have been looking through APL instead of IMA so I should be looking through IMA to see if my place is a provider within their.
[CUSTOMER][NEUTRAL] That'll take them I guess.
[AGENT][NEUTRAL] Yes, let me see what the network is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] OK, so yes, there is a network, it's multi-plan.
[AGENT][NEUTRAL] Um, and you can look
[CUSTOMER][NEUTRAL] OK, yeah, that's mhm.
[AGENT][NEUTRAL] Yeah, you can look to see if they're in network. I can also transfer if you want to talk to them, but you can also go to [PII] and then see if they are.
[CUSTOMER][NEUTRAL] Yeah, yeah, I, that's where I went, that's where I went and saw that they were within, you know, the quote unquote network and so then.
[CUSTOMER][NEGATIVE] Yeah, I guess I now I just need to understand then why they told my OBGYN that they won't cover it.
[AGENT][NEUTRAL] Let me see if I have notes and see what happened. Let's see.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] You know what uh provider your what's your provider's name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, it's called Spring OBGYN in [PII].
[AGENT][NEUTRAL] OK. I don't show a call from them. Um, we do log all of our calls.
[AGENT][NEUTRAL] So I don't see that they have called and we, we had a provider call for claim status on a
[AGENT][NEUTRAL] Claim a prior claim, but that was from [PII].
[AGENT][NEUTRAL] But I don't see any, I don't see any notes in here that they've called us so if you wanna give them the number that you just called, um, and see if they can maybe call back and re-verify we'd be happy to, you know, explain what benefits you have.
[CUSTOMER][NEUTRAL] Yeah, I mean, I, they said they called you guys, so I guess, OK, so the thing is is like there's like.
[CUSTOMER][NEUTRAL] Hold on, let me just double check. There's like 3 different phone numbers on this.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean they could have called a few but they they told me they called they have record of it they called around like [PII] today and they they said they called twice so they called at least.
[CUSTOMER][NEUTRAL] APL today and then the IMA number.
[AGENT][NEUTRAL] OK. Yeah, I, I mean.
[CUSTOMER][NEUTRAL] But you're saying there's no record of it.
[AGENT][NEUTRAL] I don't have a I have a record that you spoke with [PII] earlier today, um, but I don't have a record that we've spoken to any providers, so, um, and then our number.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] So, well, here's a, here's an, yeah.
[AGENT][NEUTRAL] Sure, go ahead.
[CUSTOMER][NEUTRAL] Yeah, so what they told and, and I'm sorry to interrupt, but so they told me they, they called you guys, but they gave my policy certificate number and your team told them that that number doesn't exist.
[CUSTOMER][NEUTRAL] Or that I nothing popped up so that may be why.
[CUSTOMER][NEGATIVE] There are no notes specifically to me.
[AGENT][NEUTRAL] Like it could be.
[CUSTOMER][NEUTRAL] Or my account or whatever.
[AGENT][NEUTRAL] Yeah, we, we do, I, I will say we do have a few new people, so they may not have. There's a process that we follow, um, with your group, um, so we know to look up by name or social as well, and that may have been missed, um, and that could absolutely be our bad. So, um, if they can give us a call back, um, I'll, I'll put a note in here too, you know, so sorry about that if they did, I just don't have any record.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's OK, so.
[CUSTOMER][NEUTRAL] Got you. So, OK, I just wanna make sure they get sent to the right place because I was, OK, so they call you guys at the number, the [PII].
[CUSTOMER][NEUTRAL] They give you either my policy er number or the medical ID number. Once you guys have the medical ID number, you guys can identify that I'm under 90 degrees first.
[AGENT][NEUTRAL] Yeah, let me
[CUSTOMER][NEUTRAL] Whatever it's called 90 degrees.
[AGENT][POSITIVE] Yes, let me give you your policy number that they would be getting benefits from though, if you don't mind. That way there's no confusion when they call.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, give me a quick second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] just
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, so my policy, sorry, you're saying the policy number? Yeah.
[AGENT][NEUTRAL] Yes, policy number is 251-0235.
[CUSTOMER][NEUTRAL] OK, so there's weirdly a 0 in front of this.
[AGENT][NEUTRAL] That's fine. It doesn't matter. Yeah, either one works.
[CUSTOMER][NEUTRAL] Number it's 0215 OK OK 0 0215 or 02510235, that's the number.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, yeah, that's the number that's on here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they have to give that number and the medical ID number and they should confirm everything or are they just gonna transfer them over to 90 Degrees because I that's the that's who I told them to call.
[AGENT][NEUTRAL] No, no, we, we will talk to them and get, I'll get someone on the line will give them the information I just gave you. The benefit is the $75 for a wellness exam, so.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] You so you guys are partially covering it because the the cost is more than that, so I don't know if that could be any sort of reason why they would decline it.
[AGENT][NEUTRAL] Yeah, but
[CUSTOMER][NEUTRAL] Or that shouldn't be an issue sorry I I don't really know how this process works.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, that, I mean, that shouldn't be an issue. Um, yeah, we, I mean, we just quote what your benefits are, so.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, um, I appreciate it so I'll have them kind of recall you guys, confirm, and then, um, figure it out from there. I appreciate it.
[AGENT][POSITIVE] OK, OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Yeah, of course you too have a good one bye.