AccountId: 011433970860
ContactId: 75e2c218-fb11-4ed1-a698-e7818b0f13e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451019 ms
Total Talk Time (AGENT): 205148 ms
Total Talk Time (CUSTOMER): 158982 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/75e2c218-fb11-4ed1-a698-e7818b0f13e1_20250210T20:13_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], uh, good afternoon. My name is [PII]. I'm trying to verify coverage and check status for a patient, please.
[AGENT][NEUTRAL] I can help you, [PII] you said [PII]?
[CUSTOMER][NEUTRAL] I did, yes, ma'am.
[AGENT][NEUTRAL] OK, and what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Um, I believe it's D like David 41203456.
[AGENT][NEUTRAL] OK, would you happen to have a copy of the medical ID card for American Public Life?
[CUSTOMER][NEUTRAL] Uh, uh, I think so. Let me just grab it really quick.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Alright, so on the card, uh, it says medical, it says.
[CUSTOMER][NEUTRAL] Uh, MEC coverage, Walmart virtual care, Walmart Health on the back it says 90 degree benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Benefit and a card um payer ID I'm looking for an ID uh employee number D like David 41203456. It says Creative circle on the front.
[AGENT][NEUTRAL] OK, that's the employer's name, so the D number that you have is unique to 90 Degrees. They're the administrator for this plan. What phone number did you dial? Did you dial [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because that's on the card.
[AGENT][NEUTRAL] OK, and that's the right number I think the option selected is um which option did you choose?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I think it's
[CUSTOMER][NEUTRAL] I honestly don't remember. I wanna say.
[AGENT][NEUTRAL] Yeah, I think the correct option is option one that gets you to 90 degrees and you're just wanting to verify eligibility and did you say benefit information?
[CUSTOMER][NEUTRAL] Go ahead I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I needed to verify their coverage and I and we submitted a bill for processing for claims so I wanted to get status on the bill as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, spell the patient's first and last name.
[CUSTOMER][NEUTRAL] Uh, first name is [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then the last name, I'll spell it for you is [PII], I guess.
[AGENT][NEUTRAL] OK, OK, OK, give me one second. What's a good callback number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And what is [PII] date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. What's his date of service?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] And the total charge?
[CUSTOMER][NEUTRAL] $22,957.
[AGENT][NEUTRAL] OK. Is that for a diagnostic test?
[CUSTOMER][NEUTRAL] No, um, that he, it was an ER visit through the facility HCA Florida University.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, he has a medical policy with us, um, with 90 degrees, he could have some type of a medical policy and perhaps a wellness policy. Uh, what I'm gonna do, the claim that we have on file for him is for that date of service, but it looks like it's a diagnostic test.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I need to talk to 90 Degrees to get status on his on his actual hospital bill.
[AGENT][NEUTRAL] Well, that probably will come to us eventually, but I want to at least see if they've received the claim on their end so um I'm gonna. Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So let me ask you what, I don't mean to interrupt. I'm sorry, so 90 degrees is that the is that you are you referring to is that the actual insurance is that the network that's being repriced through? Are they the repriser?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, 90 Degrees is the company that processes the claims if, if, if it's covered under their policy and like I was saying they usually have a wellness policy and then sometimes they may have a small medical policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, to, to pay charges that are as a result of an accident or a sickness versus a wellness or screening claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and so we try to, you know, uh, reach out to them just to verify in this instance, like did they receive your claim? Um, I think ultimately it would come to American public life to process because your medical policy is with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we would process that ER claim.
[AGENT][NEUTRAL] And it may be repriced through that entity. I'm not for sure, um, that would be a question for them and then it's sent to American Public Life to pro actually process the claim for a benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, and, and it's to be sent there, um, in case you know the provider is contracted with multi plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then it may be repriced somewhere along their process.
[AGENT][NEUTRAL] And then sent to APL to process for payment.
[CUSTOMER][NEUTRAL] OK, so who do I just need to talk.
[AGENT][NEUTRAL] Did you, did you get all of that?
[AGENT][NEUTRAL] Yeah, I'm gonna, I'm gonna.
[CUSTOMER][NEUTRAL] Not really if you want me to be honest, yeah, I just honestly all I really wanna know is, is if the bill is there and I just wanna confirm has been for processing.
[AGENT][NEUTRAL] Yeah, I'm
[AGENT][NEUTRAL] Yeah, so I'm gonna have to confer with um.
[AGENT][NEUTRAL] 90 degrees first because I have a medical policy but I don't show your claim so I can provide the benefit but I wanna reach out to them first so I'm gonna place you on a brief hold and give me that D number, give me that D number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, you're fine, go right ahead.
[CUSTOMER][NEUTRAL] 0, uh, 412-03456.
[AGENT][NEUTRAL] OK, hold on a second.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a car. We're sorry, but all agents are currently unable to take your call. Please leave a detailed message after the beep.
[AGENT][NEUTRAL] OK [PII], their phones are busy and they were wanting to route me to a voicemail. I didn't want to do that without notifying you, so it's up to you. I can transfer you back to that number that you dialed and it is option one and then you can wait for the prompt to leave a message and just let them know that you're wanting to check a status and you know give your date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's fine. Go ahead.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for calling 90 degrees. We're sorry, but