AccountId: 011433970860
ContactId: da754a28-cb5d-4be5-bccf-2d95d9022438
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426359 ms
Total Talk Time (AGENT): 155978 ms
Total Talk Time (CUSTOMER): 181310 ms
Interruptions: 5
Overall Sentiment: AGENT=-0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/da754a28-cb5d-4be5-bccf-2d95d9022438_20250625T18:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII] and I'm calling from Mercy. Um, I have received some scanned letters from you guys about a patient's premium, um, not being paid for dates of service were received and I just wanted to make sure um that nothing had changed before I billed this patient.
[AGENT][NEUTRAL] Oh, OK, uh, we're just needing to see if that um they had been paid for that data service.
[CUSTOMER][NEUTRAL] Yeah yeah I just wanted to verify everything's good.
[AGENT][NEUTRAL] OK. Sure.
[AGENT][NEUTRAL] Yeah, I can check that. I can see if there's been an update regarding that. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII] and that's correct.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, I show it as D as in Delta 44504807.
[AGENT][NEUTRAL] OK, so that is not one of our policy numbers, [PII], that is through, uh, they're called 90 degree Benefits. Um, I can give you their information and transfer you to them if you'd like or if you have their social, I can see if they have a policy with us.
[CUSTOMER][NEUTRAL] I mean, OK, so on the American Public Life Insurance Company it says policy number 025.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 76527
[AGENT][NEUTRAL] OK, yeah, that's, that's ours. Give me just a moment.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] The patient is [PII], Barnett [PII]. I believe they'd be a dependent.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it thank you so much for verifying that OK and then uh what was the do you have that original claim number?
[CUSTOMER][NEUTRAL] Um, let's see here. What is this? Does this show me a date of service on.
[CUSTOMER][NEUTRAL] Probably not.
[CUSTOMER][NEUTRAL] Just give me one moment, uh, 361-266-9.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so that was for the date of service of [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Give me just a moment.
[AGENT][NEUTRAL] OK, so I am not showing that there has been any update uh for this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So I was just curious, this is an interesting one.
[CUSTOMER][NEUTRAL] Is 90 degree your guys' pricer and then you guys are the benefit?
[AGENT][NEUTRAL] No, so it is very confusing, um, so this particular policy is a part of a multi plan, um, so if, for example, um, they have a separate policy with 90 Degree, uh, that's I believe that one is more along the lines of like wellness and preventative, whereas this is their, uh, it's a hospital indemnity medical plan.
[CUSTOMER][NEUTRAL] OK. 00, so, uh.
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] Is that like maybe they had maybe she had a build up beforehand?
[AGENT][NEGATIVE] It is, it can be very confusing.
[CUSTOMER][NEUTRAL] No, how did this, I, I can't figure out how this, yeah, I don't know how this claim would have got to you guys, um, and I only say that because on it we sent it to IMA.
[CUSTOMER][NEUTRAL] [PII] with that D number.
[AGENT][NEUTRAL] Uh, so that, that is 90 degree benefits. That's the, um, 90 degree and IMA they're that's the same, um, so I'm not quite sure.
[AGENT][NEUTRAL] Um, do you want their information? I can give that to you.
[CUSTOMER][NEUTRAL] Uh, yeah, what's their claims department?
[AGENT][NEUTRAL] It very well might have been the same number that you called honestly um their prompts can be a little bit confusing um give me just a moment let me get that pulled up.
[AGENT][NEUTRAL] There we go, OK, so their phone number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and to get to 90 degree or IMA you would select option one.
[CUSTOMER][NEUTRAL] Yeah, no, the, the, um.
[CUSTOMER][NEUTRAL] The letter was American Public Life Insurance Company explanation of benefits, um, and that's why I was trying to figure out.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] How you guys got this claim. I, they would have had to have forwarded it to you because we didn't send it to you guys. And so that's what's confusing me is we didn't even have the policy. I don't know why they would have forwarded it um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, OK, so this policy number is 02576527. Uh, call American Public Life Social Care state no changes. Yeah.
[AGENT][NEUTRAL] Correct, that's their policy APL.
[CUSTOMER][NEUTRAL] This is a hospital indemnity.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it's not health insurance.
[AGENT][NEUTRAL] Um, not in the traditional sense, no. Um, it's a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] OK, and she is not a.
[AGENT][NEUTRAL] but considered more supplemental.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Insurance and um.
[CUSTOMER][NEUTRAL] Patient is not currently active. Do you have that termination date for non-premium payment?
[AGENT][NEUTRAL] Let me see, give me just a moment.
[AGENT][NEUTRAL] Back here.
[CUSTOMER][NEUTRAL] I think that was confusing our registration department because we were calling I am uh yeah we were calling them and they're like no, she's active.
[AGENT][POSITIVE] All of it is trust me.
[AGENT][NEGATIVE] It's even more confusing.
[AGENT][NEGATIVE] Right, it's even more confusing trying to explain the whole multiplan thing to the actual um members because you know most of the time they're they have no idea so.
[AGENT][NEGATIVE] It can definitely be a big mess.