AccountId: 011433970860
ContactId: b64457df-43a8-47a3-b6dd-d91ba824ef80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473350 ms
Total Talk Time (AGENT): 230380 ms
Total Talk Time (CUSTOMER): 209365 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/b64457df-43a8-47a3-b6dd-d91ba824ef80_20250425T15:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was actually had a question about Mac, but whenever I call that number since this morning, nobody answers or calls back and it just disconnects. Would you know any like a basic question about Mac?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it depends. Uh, what, what's the, are you the insured?
[CUSTOMER][NEUTRAL] No, I'm not the insured. Um, the insured is my partner and we're just deciding whether or not to go with the Obamacare plan or the MEC. And the only question I had is, you know how when you have a regular insurance plan, you get a negotiated rate. So just say you go in for an ultrasound of your, um, I don't know, your liver, and like the hospital like the hospital charges $2000 but then.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The insurance has a negotiated rate of like 200, right? So with like, like I have regular health insurance, so that's how I get so with [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, we were just wondering like, do you still get a negotiated rate, like, you know, for those things like if you went to the hospital for an ultrasound, does he get the, I guess, discounted version, or does he have to, or does Mac not have that and he would just pay whatever the hospitals decide, like 2000 or 5000 or whatever?
[AGENT][NEUTRAL] So when you say Mac, Mac is like a type of a type of
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] uh company with typically it is with our hospital indemnity policies. When that um
[AGENT][NEUTRAL] When that happens, when a claim comes through, it goes to um a company called IMA who does kind of like what you're asking for repricing and provides discounts or benefits, and then it comes to us after, you know, whatever is applied and then we finish processing the claim out. So,
[AGENT][NEUTRAL] I guess to answer your question, yes.
[AGENT][NEUTRAL] There are, we do uh have IMA which is free pricing and um yeah, they do give like, you know, discounts or benefits or try to see if they can, and then it's sent to us.
[CUSTOMER][NEUTRAL] Is IMA a company? Because I thought when I called this number it said thank you for calling IMA so am I, is that who I'm speaking to right now?
[AGENT][NEUTRAL] No, this is APL. So APL um is the insurance company, but um, IMA, that's the name of the repricing company. So there, I mean, you can reach them for like if you had claim status questions or something like that, but um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] That's pretty much what we use them for. I don't know what else, you know, if they offer other types of services, but for APL it's just like re-pricing for our claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and would you be able to transfer me to like or to one of the people who specializes in these because every time it says for Mc questions press one and then you push it and nothing happens. So do you like do you have a coworker or somebody else that you could transfer me to that works in Mac?
[AGENT][NEUTRAL] So I don't, um, are the, so for APL.
[AGENT][NEUTRAL] So are you trying to get the policy through the employer because I'm hesitating or trying to think through it because all of APL's policies is through the employer. So unless there's like a policy that's already been generated, we for we tell them.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, OK, so this is the problem, he, he has the policy. Here's the card and it says um.
[CUSTOMER][NEGATIVE] For medical benefit customer service called 90 Degree Benefits at [PII] and it has a payer ID. So he already has this, but I think it's useless. I was gonna get something on the Obamacare website. That's why I just wanted to know. So are you 90 degree benefits?
[AGENT][NEUTRAL] Um, so I see what happened here. So did you call the [PII] number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that's what happened. OK. So you called 90 Degree Benefits. That's why I only said 800-833 because I don't know the rest. It's a different company, but there's an option on there like automated system, no matter what you press, it'll send the caller to us. So that's what's happening here. You got redirected because our phone number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] But that it's starting to happen a lot more and I, I guess maybe because they can't get through.
[AGENT][POSITIVE] Now that's starting to make sense.
[CUSTOMER][NEGATIVE] Yeah, cause I can't, I've been drinking this morning and I can't get anything to go through.
[AGENT][NEUTRAL] I'm gonna forward that over to my supervisors and let them know that because, yeah, I wonder if that has anything to do with the redirecting.
[CUSTOMER][POSITIVE] That's why I was like, OK, finally.
[AGENT][NEGATIVE] Because they're not answering the phone.
[CUSTOMER][NEGATIVE] Maybe the line just cuts out.
[CUSTOMER][NEGATIVE] Yeah, they don't answer it. It's just, sometimes you'll hear a click and then it just goes away. And it's been since this morning. I was like, that's why I was wondering if you had like a direct way to for me to transfer me to them instead of using the phone number where you just get cut off.
[AGENT][NEUTRAL] Well, let's do, oh, let me try this. On the ID card that you have, do you see anywhere that says like in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] No, it has like a
[CUSTOMER][NEUTRAL] Employee ID number.
[AGENT][NEUTRAL] Does it start with a 01 or a 02?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Oh, I, I was trying to see if maybe I could pull, try to pull a policy here and help you, but it sounds like this.
[CUSTOMER][NEUTRAL] Oh, it says medical claims submission. It has an EDI number.
[AGENT][NEUTRAL] Mm that's different.
[AGENT][NEUTRAL] OK, so it sounds like you have your medical policy is with a company that works with 90 Degree benefits and
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You got redirect. I, I'm sorry, I wish I had better news for you because I was definitely gonna try to pull a policy and help.
[CUSTOMER][NEUTRAL] OK. No problem. Um, so I guess maybe if there's any way for you to get them, well, I don't know if you can, like get them to fix their phone because it's like every time you call them, you can't get through to them.
[AGENT][NEGATIVE] Yeah, I'm definitely mentioning this to my supervisor because we have been or I've noticed at least an influx of calls being redirected and I'm wondering now if it's because they're not there to help the patient and then it just rolls, you know, just comes over to us um and then the patients get frustrated because they're being sent all over the world.
[CUSTOMER][NEUTRAL] Probably
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, and then they have this thing that says we open at [PII] or [PII] and we're closed, but it doesn't say what time zone, so you keep calling at [PII] and they're closed, but who knows maybe it's [PII] Pacific time. So then I waited for it to open and it's like the most useless phone number. It's like they don't pick up when they're supposed to be open. They don't pick up now and even in [PII] it should be [PII] by now, but they don't pick up.
[CUSTOMER][NEUTRAL] Oh well.
[AGENT][POSITIVE] Well, I'm definitely sorry for this experience. I wish I could help you more. I don't know how though, um, because it
[AGENT][NEUTRAL] I mean, if you want me to look it up with the name.
[CUSTOMER][NEUTRAL] Maybe I'll try email because they do have an email address I think on the card.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Now, you might get faster help with email and make it urgent.
[CUSTOMER][NEUTRAL] Maybe I'll try that, all right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome. Well, was there anything else I can help with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you all have a great weekend.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.