AccountId: 011433970860
ContactId: 9dfcb794-0781-49b0-9156-3f503d754f69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502519 ms
Total Talk Time (AGENT): 245636 ms
Total Talk Time (CUSTOMER): 200401 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/9dfcb794-0781-49b0-9156-3f503d754f69_20250625T19:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name's [PII], um, and I'm calling because I had spoke to [PII] earlier about a patient and I just got off the phone with 90 degree Benefit and I had some follow up questions.
[AGENT][NEUTRAL] OK, sure, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] and that's correct.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 025765
[CUSTOMER][NEUTRAL] 27
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] This is [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And how may I assist you with this patient?
[CUSTOMER][NEGATIVE] Um, I had spoke to [PII] earlier and um she stated that this member was currently suspended and not active due to nonpayment of premium because I have 3 claim denials with letters from you guys stating that that hey, this member is suspended for nonpayment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] What then she directed me to call IMA 90 degree Benefits and when I called them they said this member is active and they never received these claims from you guys. They told me that APL is responsible to forward the claims to them.
[AGENT][POSITIVE] OK, I'm sorry for, no, no, no, I'm so sorry for all that.
[CUSTOMER][NEGATIVE] I'm super confused.
[AGENT][NEUTRAL] OK, Ms. [PII], um, we are, OK, so we have the policy, the policy is set up with benefits on a card. Benefits and a card is the third party that works together with the employer that gets this policy together for the member. OK. May only handles preventative, so no, it has nothing to do with what we're doing right here. OK, so preventative is the only thing that IMA 90 degree works with.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, whenever we denied a claim indicating that the premium was not received and that's the reason that we have not paid is because we're waiting for benefits in a car which is the third party to let us know that this member is still with the company.
[AGENT][NEUTRAL] So once we receive that information, we will reprocess the claims, but um if the policy is terminated, it's just not going to reprocess. Let me check and see if the policy has a lapse in coverage. Um, let me just go ahead and get that information for you, OK? Let me check the lapse in coverage.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK, and, and this is temp agency, so they, they don't work all the time. They don't pay all the time, OK? So let's see. So I do see there's a lot of lapse in coverage for this member, OK? Um, so basically, mm.
[AGENT][NEUTRAL] Half of January is slabs.
[AGENT][NEUTRAL] February, March, April is laps. May is the only one that's paid fully.
[AGENT][NEUTRAL] June, we're still waiting.
[AGENT][NEUTRAL] In July, well, we, we haven't got to July yet, so yeah, there is a lot lapse in coverage for this member and that's the reason we denied those claims.
[CUSTOMER][NEUTRAL] OK, I guess I was trying to better understand.
[CUSTOMER][NEUTRAL] So we filed these claims electronically to IMA, but somehow they got to you guys.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and that's how it goes because they.
[CUSTOMER][NEUTRAL] Was that, was that correct?
[AGENT][NEUTRAL] Yes, they only process for preventative, so the only thing they're gonna do is process preventative and if there if there's no preventative in that claim, they're just gonna go ahead and send it to us. That's all they do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] This routed to them correctly.
[CUSTOMER][NEUTRAL] If there was no, and these are not preventative, of course.
[AGENT][NEGATIVE] You're not.
[CUSTOMER][NEUTRAL] OK because yeah she was like telling me that uh basically she's like we've never seen these claims we have no claims on file for this you know kind of thing we show her as active and I'm like well I'm not for sure what to do in that situation so it kind of sounds like the member was at least lap so I have a data service of 211 of [PII] and 325 of [PII] those for sure are not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Those are unable unless they go back and pay the premium kind of thing right now it's patient responsibility.
[AGENT][NEUTRAL] Unless they, yeah. Perfect. Yes, that's it. Yeah, if they go back to benefits in a car, which is the third party, um, I'm not sure how long they have to cut up their policies, but sometimes they do have like sometimes to do it. I don't know if it's 30 days, 60 days, but they can check the benefits in a car and see exactly how long they have to go ahead and get caught up with those payments.
[AGENT][NEUTRAL] With them.
[CUSTOMER][NEUTRAL] OK, I wonder why, um, I wonder why their 90 degree is active, but you guys aren't if they're all in one. That's kind of odd but OK um.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Oh, but we are active. The policy is active, it's just a lapse in coverage.
[AGENT][NEUTRAL] Because like I said before, these are, this group is a temp agency, so whenever they have a job they get paid and they get paid for their premiums, um, but when they don't have a job they don't get paid so more than likely if they don't pay out of pocket they don't get paid for their premium so it's temporary jobs, so that's how it works.
[CUSTOMER][NEUTRAL] Oh, I understand. OK, I get you. I know how that goes. OK, so let's see, uh, because, uh, so then the claim won't go to 90 degree benefits, which explains why they don't have them, um, because these are not gonna be covered. And then the next one I have is a [PII], um, and have you got, I'm guessing same thing it's.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me check on that one.
[AGENT][NEUTRAL] OK, let me look at.
[AGENT][NEUTRAL] OK, let me look at the payments again.
[AGENT][NEUTRAL] I thought we had everything for 6. Let me double check. Oh no, we have not received any payments for 6 yet. No, yeah, we're still waiting on those.
[CUSTOMER][NEUTRAL] OK, got you. So I will put it here for 46 25 2025, still awaiting premium payment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][POSITIVE] And then I'll know to call back in 30 days and if they haven't made that payment then I'll know what to do from there. No, you explained that so well. I was so confused. I was like how are these claims going here or there and OK so uh that works perfect and I appreciate it.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] 95.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, I just need uh a good call reference number.
[AGENT][NEUTRAL] Well, we don't have reference numbers. You can use my name in today's state. You need the spelling?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[AGENT][NEUTRAL] OK, sure. Yes. That's [PII].
[CUSTOMER][POSITIVE] All right thank you so I hope you have a great day.
[AGENT][POSITIVE] You're welcome. You as well. Have a good afternoon and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye-bye.