AccountId: 011433970860
ContactId: 9003a766-91e3-441f-83a5-52fda44f3247
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1345000 ms
Total Talk Time (AGENT): 551372 ms
Total Talk Time (CUSTOMER): 472576 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/9003a766-91e3-441f-83a5-52fda44f3247_20250610T18:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling because um I uh received a bill from my uh medical provider and they are charging me full for the bill fully, um, but I was told by your team previously that you had not denied the claim that you guys were going to cover, um.
[CUSTOMER][NEGATIVE] Uh, you guys were gonna cover 220 of the bill, um, but then that that was the conversation I had, um, but I actually called back my provider and now they're telling me that the claim was denied from the beginning so I'm just trying to get some clarity on this whole situation.
[AGENT][NEUTRAL] OK, so you're the insured and you're calling about the status on a claim that we received from your provider, is that correct?
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with?
[CUSTOMER][NEUTRAL] Um, [PII] with an [PII], um, [PII].
[AGENT][POSITIVE] OK, thank you and Miss [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is your policy number, please?
[CUSTOMER][NEUTRAL] Uh, my policy number is
[CUSTOMER][NEUTRAL] Um, 02510235.
[AGENT][NEUTRAL] OK, Miss [PII], thank you. Give me a couple of moments please to get your policy information pulled up first off. Once I do, I will have to verify several things with you for security and also any information that it's provided would be a verification of benefits and not a guarantee of payments. So one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Bye.
[AGENT][NEUTRAL] Alright, so first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm it's [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you and lastly your email address please?
[CUSTOMER][NEUTRAL] Uh, my email address is my first name, um.
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] OK, thank you very much. Now I can see Ms. [PII], that in the past you had set up your profile in the online service center with APL.
[AGENT][NEUTRAL] There has been an update in our system, so you will need to create you a new profile you won't be able to log in with your information that you set up before now I do have some user guides for the new portal that I would be happy to send to you if you would like for me to email you those.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yeah, that would be great.
[AGENT][NEUTRAL] OK, alright, well, give me just a second. I'm gonna go ahead and do that before we look at your claims.
[AGENT][NEUTRAL] And Miss [PII], the information that or the email that you're receiving, it's going to come from [PII]. So if you don't see that in your regular inbox, you know, pretty soon you might wanna check your.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It should, yeah.
[AGENT][NEUTRAL] junk or spam folder, but hopefully it won't go to there. OK, right, so just.
[CUSTOMER][NEUTRAL] OK, will do.
[CUSTOMER][MIXED] Yeah, I think I have it set to not send but that's fine.
[AGENT][NEUTRAL] OK, OK, so just a moment.
[CUSTOMER][NEUTRAL] Oh, got it.
[AGENT][NEUTRAL] Did you receive it? OK, great. So that should have, it's got two guides, one's about setting it up and then the other one's just uh information on using it, some of the difference, differences in it. OK, so what is the date of service for you that's in question?
[CUSTOMER][NEUTRAL] Mhm yep.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it would have been [PII], would have been the day I got the, I went to get my wellness check.
[AGENT][NEUTRAL] Alright, so we have a couple of different claims for you for that data service. Let me find the original one that was received.
[CUSTOMER][NEGATIVE] Yeah, so what I was told originally was that they had sent a claim and I was told by your team that you guys had approved it and everything was fine and then the provider sent a second claim kind of like double and you guys had rejected that one, and I told the provider that they're like yes that makes sense but they also told me that your team had not approved the first one and that's why I'm seeing that bill come up so that's probably why you're seeing too.
[CUSTOMER][NEUTRAL] You might be seeing multiple claims from the same.
[AGENT][NEUTRAL] OK, so the, the original claim that was received, we did pay.
[AGENT][NEUTRAL] Now, what is the provider that you're calling about? What's the
[CUSTOMER][NEUTRAL] I just know the Mount Sinai.
[AGENT][NEUTRAL] Provider facility. OK. Now, I can tell you that we've received.
[AGENT][NEUTRAL] The first claim that we received was for Laboratory Corporation of America.
[AGENT][NEUTRAL] And that had to do with wellness. We did pay a benefit to them in the amount of $250.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, wow.
[AGENT][NEUTRAL] Because that was the first claim that was received. Well, no, give me just a second, I'll go back to that screen.
[CUSTOMER][NEUTRAL] LabCorp is who you pay for.
[CUSTOMER][NEUTRAL] 250 OK.
[AGENT][NEUTRAL] And with that payment,
[AGENT][NEGATIVE] The calendar year maximum for this benefit was exhausted.
[AGENT][NEUTRAL] With that first claim that was received, OK, because we process them in the way in the order that they're received now that shows on here on this claims information laboratory corporation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of America.
[AGENT][NEUTRAL] It's how it's worded.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] And then the other claim I guess, what is that?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or were there any other claims that were shared?
[AGENT][NEUTRAL] Yeah, give me, yeah, but OK, so that's, that's that one and I showed that there was also.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Pay to you a $5.70 benefit.
[AGENT][NEUTRAL] On that same claim, OK? Now, let me look at the next one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So then we did, we, we received that same information a second time from that same.
[AGENT][NEUTRAL] Provider, so it was denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me look at this one claim to see who this one is for.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so then there was one claim for, I don't know how they pronounce this or if this is just abbreviated, but it's BISLR Medical Group.
[AGENT][NEUTRAL] Of Mount
[CUSTOMER][NEUTRAL] B S I L R
[AGENT][NEUTRAL] No, no, no. B I S L R Medical Groups.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of Mount Sinai, I'm assuming that's Mount Sinai, it cuts it off where I can't see it because of the length. OK. So that claim that was received, that
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Was received after this other one that we processed that match your benefit, so the denial remarks for that claim from them states.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] The calendar year maxim for wellness benefit has been met.
[AGENT][NEUTRAL] And the other code being a puncture is not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was the
[CUSTOMER][NEUTRAL] Sorry, what was that secondary thing?
[AGENT][NEUTRAL] Venna puncture.
[AGENT][NEGATIVE] They stick your finger for blow vena puncture is not covered by this policy.
[CUSTOMER][NEUTRAL] Vena puncture.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and do do those have any uh like cost numbers on them?
[CUSTOMER][NEUTRAL] Are you able to see that?
[AGENT][NEUTRAL] I can't say that. No, ma'am. I can't say that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the lab corp that was shared that just basically took that pay, you know, that paid for all all of that I had available was already done. So whatever other things that they shared for the.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] All
[CUSTOMER][NEUTRAL] Uh, BISLR Med Group, Mount Sinai, and then Bea puncture is not covered, um, so, OK.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] But that's why we received that oh, I'm so I did not mean to overspeak you. I'm so sorry.
[CUSTOMER][NEUTRAL] OK then I will go back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, no, no, no, no, that's fine.
[AGENT][NEUTRAL] Yeah, so we just received that we received because because of the way claims are processed and the order that they're received when we received that first claim that had all of the.
[CUSTOMER][NEUTRAL] No, no, please go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] The lab, from that lab, we were able to pay the benefits on that, we paid $250 on that total claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] Yes. Does that.
[CUSTOMER][NEUTRAL] OK, that makes sense, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I actually had an additional question so with all of that that um.
[CUSTOMER][NEUTRAL] So a secondary question that I had is, after all of this, um, I tried to get a, um, sorry, excuse me, I have a million people call me. Um, I tried to set up an appointment with my gyna uh gynecologist back in, I wanna say like March or April, um, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Might be because of all this, but basically, and I'm pretty sure like I'm almost 100% sure that this provider was approved like is in your network, but basically.
[CUSTOMER][NEGATIVE] When they called the insurance, they basically told them that they wouldn't cover my gynecologist appointment. Is that because, and I don't know if you can answer that, but is that because I've already spent.
[CUSTOMER][NEGATIVE] Like all everything there's nothing available that they'll cover because of this um physical that I got back in September.
[AGENT][NEUTRAL] OK. So your wellness benefit had been exhausted, but I don't, do you have also like a wellness plan with 90-degree benefits or IMA?
[CUSTOMER][NEUTRAL] That's what they tell me, but then I'm told that I don't actually have it, so it's, to be honest, it's very confusing, um, and not very clear, so, um, but what I will tell you is that my, my gyno office called whoever they said.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Now,
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That they can't cover it. That that's what they were told. um I got the run around. I was told talk to 90 degrees. I technically don't have 90 degrees for some reason. I don't know. So.
[CUSTOMER][NEGATIVE] You know, I, it sounds like I don't, I don't have, I can't go get a kno appointment because everything's been exhausted through this one physical.
[AGENT][NEUTRAL] For that, for that calendar year. Under this plan, the maximum for a wellness, yes, it has been maxed on this. Now, this policy has benefits like if you were sick and had to go to the doctor, you have visits. But as far as a wellness exam or, you know, test, yes, this policy has exhausted that benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Does that make sense? Now, I do want to look at some notes on your policy though.
[CUSTOMER][POSITIVE] Yeah, that makes sense.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because unfortunately we can't, if you do have a policy with 90 degree benefits we cannot see that information, yeah, so um I can't.
[CUSTOMER][NEUTRAL] Yes, they did tell me that, yeah. Mhm. That's fine. Yeah, I don't think I actually do. I just think.
[CUSTOMER][NEUTRAL] Because of the company I'm with, it's like it's, it shows on like my on certain cards that I have but I don't technically have it.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] At least that's what I was told.
[AGENT][NEUTRAL] Yeah, OK. Hmm.
[CUSTOMER][NEUTRAL] But I don't know. I don't know if you uh if you guys have that in the notes or anything.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] So I mean, I can see where you called and spoken to someone here, you know, and they explained to you about what I was just saying as far as if you were sick, you do have a, you know, an outpatient sickness benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On this policy and your wellness, you do have that, however, you know, it had been.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Use for that calendar year now for.
[CUSTOMER][NEUTRAL] So, so, so basically it's like with this, I mean, in all honesty, basically what is being said here is that like.
[CUSTOMER][NEUTRAL] Based on the cost of things it's kind of a one or the other you either have your physical covered or you have your gyno appointment covered basically.
[CUSTOMER][NEUTRAL] Um, kind of the situation I'm in.
[AGENT][NEUTRAL] Again, because it's a limited benefit plan, Ms. [PII], you know, it's not major medical insurance, so it does say specific amounts for certain services. Now, if you have, do you have a D number list, like a member ID on the bottom of your card?
[CUSTOMER][NEUTRAL] Uh-huh. Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got you. OK, OK, yeah, that's fair.
[AGENT][NEUTRAL] On your ID card.
[CUSTOMER][NEUTRAL] Um, let me, yes, I do.
[AGENT][POSITIVE] OK. So that, that usually is indicative that you have some type of coverage also with 90 degrees. Yes, ma'am. Now, I would be happy to connect you.
[CUSTOMER][NEUTRAL] A medical ID I.
[CUSTOMER][NEUTRAL] I did
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] With them
[AGENT][NEUTRAL] With one of their representatives, um, and let them know that you know you're needing to a verify if you have coverage with them and B you have some questions on benefits under that plan, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[AGENT][POSITIVE] You know, I'll be happy to do that for you if you would like.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yeah, that would be helpful. Yeah, I just, like I said, it's like the, the few people I, I kind of gotten mixed messages on everything, so it's, uh, but yes, I was told that that kind of the same thing you're saying they're like, well you have that the number, so but I don't really recall what ended up coming out of that. But yes, if that would be really helpful if you could get me in contact with them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and just, um, so you know, their phone number should be on your ID card also. And for, for them, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes. Now, I will let you know that.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm, sorry, I just wanna double check [PII].
[AGENT][NEUTRAL] Go ahead.
[AGENT][POSITIVE] Yes ma'am, that is correct. And when you call that number, option 1 will take you to 90 degree benefits.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Option 2 we'll bring you back here to [PII] just so you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, well, do you have any other questions that I can try and answer for you or?
[CUSTOMER][POSITIVE] Great, that's really helpful.
[AGENT][NEUTRAL] Today? Anything I can help you with on the policy here?
[CUSTOMER][NEUTRAL] No, I think that I think that covers it.
[CUSTOMER][NEUTRAL] No, I think that's helpful. Um, yeah, I'll go back to, uh, [PII] and just see if they can confirm that what the balance I have is, is like what's left over after you guys have already covered everything.
[AGENT][NEUTRAL] OK, and you would still like for me though to try and connect you with 90 degree benefits, right?
[CUSTOMER][POSITIVE] Yes, that would be great, mhm.
[AGENT][POSITIVE] OK, well, I'll be happy to. So if that is all then that I could help you with, it was my pleasure in speaking to you today, Ms. [PII], and I hope that you have a very nice rest of your day.
[CUSTOMER][POSITIVE] Thank you you have a good one too.
[AGENT][POSITIVE] Yes, ma'am. Oh, thank you very much. So one moment, please.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you for calling 90 Degrees. If you would like to participate in a quick survey, all agents are currently assisting other callers. Please remain on the line and your call will be answered by the next agent.
[CUSTOMER][POSITIVE] We appreciate your call.
[CUSTOMER][POSITIVE] We appreciate your patience. Please remain on the line, and we will be with you shortly.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voice.
[AGENT][NEUTRAL] Ms. [PII], this is still [PII]. So I was holding for a representative, but after, you know, a period of time, it's now apologizing for the lengthy delay and wanting you to leave a voicemail. So I did not just want to drop you into their voicemail.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Without letting you know.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] So would you like for me to connect you back over and if it does that again just release your call to the voicemail so that you can leave a message?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] No, no, no, don't worry about it. I can, I can call them myself.
[AGENT][POSITIVE] OK. Well, I'm so sorry about that.
[CUSTOMER][POSITIVE] Oh, that's OK. I appreciate the help.
[AGENT][POSITIVE] OK, miss, well, you're very welcome. It was my pleasure and again, have a wonderful rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye