AccountId: 011433970860
ContactId: ebf47082-7b93-4075-8daf-312dc0160a22
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1890680 ms
Total Talk Time (AGENT): 738470 ms
Total Talk Time (CUSTOMER): 864689 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/ebf47082-7b93-4075-8daf-312dc0160a22_20250410T15:51_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'm calling the kind of for a few things so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I just got an email or uh a notification from my doctor that I owe a balance for a physical that I got um last year and the bill is for like full charge basically the insurance is not covering it at all.
[CUSTOMER][NEUTRAL] And so I just kinda wanna see what the disconnect is there because I should have like just an annual physical cover through my plan.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Um, and then to kind of, yeah, and to kind of compound on that, I also had some issues yesterday. I was getting my like women wellness. I was supposed to go in and get my women wellness check and the office, my OBGYN office called multiple times to APL, got in touch with 90 degree benefits, and they're basically everyone keeps telling.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My doctors that I'm not covered, so I'm just trying to figure out.
[CUSTOMER][NEUTRAL] What's going on why this is happening, yeah, so.
[AGENT][NEUTRAL] What's going on.
[AGENT][POSITIVE] OK. I'm definitely sorry for the runaround, but I'll be more than happy to um go through the policy with you and, and look at what's been going on. Um, may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][POSITIVE] It'd be great.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, um, it's [PII] and then the phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, give me one second.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Yeah yeah sorry I should have it um OK it is uh 0251.
[CUSTOMER][NEUTRAL] 0235.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Alright, and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Mhm, uh, [PII], uh, email address is [PII] and then my mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so let me take a look. Do you mind if I place you on just a brief hold? I'm just pulling up the policy so I can see all the benefits and
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, look at the notes. OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's OK. Is there another one? Oh, this is, oh, I still clicked the wrong thing. I think I yeah I did.
[AGENT][NEUTRAL] Let me go a note. Alright, so it's hustle and then what's what we, what have we told her.
[AGENT][NEUTRAL] Do do do do do do. OK, wait a minute.
[AGENT][NEUTRAL] Alright
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you so much for holding. So I looked at a couple of things. OK, so it's not that your claims aren't being um paid. So, there was a claim that was submitted initially and I'm I'm flipping through the screen, so bear with me. So there was a claim that was submitted on on um [PII], which we paid $250 towards for the for the wellness benefit. It was for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEGATIVE] The, the wellness benefit was applied to that first initial claim, so they keep submitting it, but we already paid to the first one, so we can't pay again.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So it's not that we're not paying, they're submitting the same thing over and over. I looked to see if this was like different dates of service or different amounts. This is the same claim, so that's why they're being denied a duplicates because when they sent it originally in October, it was paid. So, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's that part and then um
[AGENT][NEUTRAL] In terms of like your like your yearly or like your your women's checkup, you do have the wellness benefits and diagnostic testing benefits on your policy. Um, the only, the only like difference is for this policy it specifies what diagnostic testing is considered, but in terms of your wellness, yes, you do have that coverage. They just
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I guess maybe it was a disconnect with
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The payment, but it was because it was denied as a duplicate.
[AGENT][NEUTRAL] Because we paid it the first time they sent it in.
[CUSTOMER][NEUTRAL] OK, and are you able to see how much they.
[CUSTOMER][NEUTRAL] Requested and how much you guys because I, I know you say you paid 250.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Was it was the was was their initial claim $250 or was it more and you guys were able to pay, you know, a certain percentage? I'm just trying to understand because I just so you know I'm, I'm being billed $440 so I'm like if you guys pay $250 great, I'll just pay the other half or the other amount or I guess uh yeah are you able to see that?
[AGENT][NEUTRAL] Mhm hold on one moment, let me add it up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 6930.
[AGENT][NEUTRAL] Is that all on here? Hold on one second. I'm just trying to see if this is.
[CUSTOMER][NEUTRAL] Yeah yeah.
[AGENT][NEUTRAL] OK, yeah. So this one, it totaled $470.24 of that, we paid $250.
[CUSTOMER][NEUTRAL] OK, sorry, 470 and how many cents? Sorry.
[AGENT][NEUTRAL] Oh no, you're fine. 24 I'm sorry, $470.24. I'm sorry.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] OK, so that was the original and then you guys paid 250, so I owe, you know, whatever the math is for that, but they're charging me the full amount, um, but you're saying that they've duplicated or they've been sending you, they've basically been billing you guys over or sending.
[CUSTOMER][NEUTRAL] I don't know how the process works, but they basically are saying like, hey.
[AGENT][NEUTRAL] Yeah, so they sent
[AGENT][NEGATIVE] So basically they sent the claim 12345 times, but we paid it the first time. So all the other ones are denied a duplicate.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] And that they could be, oh sorry.
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] Oh go ahead no go ahead.
[AGENT][NEGATIVE] I was gonna say they could be trying to resubmit to see if more can be paid, but that $250 was the max. I don't know if maybe that, maybe that's why they keep resubmitting it. I'm not sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, OK, OK, that's fine and then um I just wanna make sure for my women's wellness what I was told is that you guys cover $75 of whatever they charge.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see, 75.
[CUSTOMER][NEGATIVE] I just want to understand why when my office because they called twice and they originally called APL and then I gave them the number to call 90 Degree benefits and both times they're being told there's no there's no coverage at all so I just wanna.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Kind of get some clarity on like.
[CUSTOMER][NEUTRAL] Um, who my doctor should call and who can kind of give them the yes, the green light to say yes, we will cover, you know, the $75 or whatever amount it is.
[AGENT][NEUTRAL] OK, so are you asking me like for the like, because the $75 applies to like an office visit, we'll pay 5 times a year at $75. Is that what you're meaning? Or like the wellness benefit pays $75 per test?
[CUSTOMER][NEGATIVE] I honestly, I have no, I don't really know how to ask this question, but basically what was told to my OBGYN is they called you guys they called APL they called 90 degree benefits both times they were told.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] We won't cover, there's no coverage for her.
[CUSTOMER][NEUTRAL] So I would have to pay it all out of pocket, yeah, that's the problem so I just wanna make sure.
[AGENT][NEGATIVE] No, no, that's not true.
[AGENT][NEUTRAL] Is there a way maybe I can
[AGENT][NEUTRAL] Do you have, do you want me to like maybe is there a way we can talk to them on three way? But that you, so whether it's a OB, any type of office setting OB specialist, physician, that's just straight across the board, $75.05 visits per calendar year. Now who sends the claim in first, gets paid first, but, but you do have that coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So 75 x 5, that's how much I have available to cover for whatever.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Per calendar year.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Per calendar year OK.
[CUSTOMER][NEUTRAL] Now what if, sorry this is me not being, not knowing anything about this process so what if like my amount is more than 75.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's only paying $75 for that one visit, so if my, you know, cost is $300 you guys are gonna pay $75 of that, not like, oh, since you have up to, OK, OK, per visit.
[AGENT][POSITIVE] Correct
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's just OBGYN or are there other categories that fall under wellness?
[AGENT][NEUTRAL] So, no, so this is not under wellness. So this is your outpatient um sickness rider. So it's like something you added to your policy so that you can go to the offices. Because, so basically you have a hospital indemnity policy. A hospital indemnity policy is like a limited medical.
[AGENT][NEUTRAL] Benefit policy. So if you were to go to the hospital and you're like confined to the hospital over 18 hours, there's a daily benefit for that, the intensive care unit, but you also have added the wellness benefit, diagnostic testing, um, if you're ever admitted into the hospital that first time, the policy is going to pay you 20 or up to $2500 just because you were admitted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, mhm, mhm.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and then you have the outpatient sickness, sickness rider, which is what covers the offices. It could be any type of office setting, physician, specialist, OB, I don't know, anything in the office. You just have 5 per calendar year that would pay up to the 75. So, if, if the OB uses all 5, then, you know, that's fine, but you do have that coverage. I'm, I'm sorry, that was not told correctly.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] That's yeah.
[CUSTOMER][NEUTRAL] Yeah, I just, yeah, I just don't know if it's a language issue like our the, the OBGYN doesn't know how to properly ask because to be honest this is kind of the issue I have with this insurance. This is kind of the first time I've I've always had, you know, sorry to, I've always had the big net network, you know, employee benefit, you know, kind of the answer, yeah, I've always had major medical so the problem I'm kind of running into is a lot of my offices are like.
[AGENT][NEUTRAL] Like major medical. Mhm.
[CUSTOMER][NEUTRAL] I've never seen this insurance before, so they're I think they're just, you know, coming into some struggle. So is there a way like when my OBGYN calls you guys, is there a way they can phrase it like this is specifically for this or should your team just know, hey, this OBGYN called for Eella, she has this benefit, it should cover, you know, up to $75.
[AGENT][NEUTRAL] Well, it's a little bit of both, so.
[CUSTOMER][NEUTRAL] Because I, I'm just telling you I got the run around yesterday, yeah.
[AGENT][NEUTRAL] So it's a little bit of both. I would say for when the provider calls, I would, I would tell them to just let us know that you're trying to verify office, you know, OBGYN office visit coverage. When we hear that we're going to go straight to the benefit I just read off to you, but at the same time, the representative like I did needs to be able to ask questions to get to what
[CUSTOMER][NEUTRAL] Got you, go ahead.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know, to figure out what is really needed. So it's a little bit of both, to be honest.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] OK, so is there any record that you guys have because this was kind of the struggle yesterday is that when I called you because this all happened with my OBGYN this all happened yesterday and so it sounds like.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I don't know. I don't know if you guys have records of what was discussed, what questions were asked, because again twice they called, like I said, they called you APL. They, I've your team then I had to call you guys. You guys gave me the numbers directly to 90 degree benefits, and then they called both and at and both times they were basically told.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, like she doesn't have that coverage, so you know, my, I just wanna make sure.
[AGENT][NEUTRAL] This is what I'm going to do, so that if they do call again or you know, we do have record in terms of like notes after the call, so I'm I'm typing them now. So I'm literally putting um that you call to discuss the benefits and the claims and everything that we talked about and I'm going to put the benefits in here and this is for offices um so that whether they call back or
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, one of the reps looks at the notes and see hopefully from here on, it'll be clear because my notes are here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK great yeah because when I asked um you know I I called your team and they said and they were apologetic about it but they said we don't have records of your office calling us.
[CUSTOMER][NEUTRAL] Or the OBGYN calling and again from from the record because I show up to my OBGYN thinking everything's you know clear and they said we they had their own notes of like we tried you know yesterday at this time when we they talked to [PII] and then we should they tried again and so I'm just wanna make sure that there's some sort of record so we can at least if it happens again that it's just like sorry we won't cover this at least we have notes on it.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Or if you guys say yes, so that would be helpful. I, I just don't know and, and again, your team is very apologetic. They're just like, I'm sorry, it looks like someone didn't follow protocol, so, um, you know, nothing on you guys. Everyone I've talked to has been helpful, but um just I don't know why the, the doctor's office is having a struggle. Yeah.
[AGENT][NEUTRAL] So yeah.
[AGENT][NEUTRAL] We got to get this figured out.
[AGENT][NEUTRAL] Yes, and I'm the only [PII] here. I mean, the notes are here, but I'm the only [PII] here, so if they wanted to, you know, it, it won't be hard to get to me, um, but there are, there will, there are um detailed notes on your, your um policy now, so I, I hope that we won't have to keep going through these circles, but yes, you do have office coverage through that outpatient sickness rider, the 5 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so it's outpatient.
[CUSTOMER][NEUTRAL] Oh, sorry, outpatient sickness.
[AGENT][NEGATIVE] Sickness rider.
[CUSTOMER][NEUTRAL] Writer, um, is that how they, sorry, ag[PII], I'm gonna ask these questions. I feel like outpatient just sounds, outpatient sickness sounds like, doesn't sound like wellness, so I'm just trying to like, do they need to say that?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, it's two different things. So if your OB is asking about wellness benefits, that's different. If they're wanting to know if there, if there's coverage for their office visit, that's two different things. So what's covering the OB is the outpatient sickness writer because it's an office visit and those are per visits. Your wellness benefits are like your
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It it can be both or it could be one or the other. It depends on how they send it in. So if they're just billing us for the facility charge, that's where the outpatient sickness comes in, which is the 755 per calendar year. But if you actually got something done and they're billing us for the services too, then that's when the wellness benefits or diagnostic testing comes in, depending on what you had.
[AGENT][POSITIVE] So it could be multiple benefits.
[CUSTOMER][NEUTRAL] So it's two different requests.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so like, let's, so when you say like if I go in and I'm getting a pap smear and that's it, that's, that's just an office visit, that's fine, or does the fact of the pap smear now means I have to, they have to request a separate thing because that's a test.
[AGENT][NEUTRAL] Well, no, that it depends on their billing. So some places will bill just for the services. Some places bill for the facility and the services. Some places build the facility, the service and the doctor. So it just depends on how they do their billing. If they're just billing for the visit, then just the visit benefit would be used. If they've been, if they're billing for just the service, then it's just wellness. If it's both, you'll see both benefits on there being applied.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that's just the going process, so there should be no sort of like if they if they're talking to your representative, they're not gonna be like, oh well.
[CUSTOMER][NEGATIVE] I guess they won't come back them on it and tell them like no she doesn't have any sort of coverage.
[AGENT][NEUTRAL] Correct, because you have coverage for the, for the wellness, you know, no, I understand you have coverage for the wellness, so that, you know, your yearlys and everything, and then you also have the visits from the sick the outpatient sickness rider. So it really just depends on how they do their billing and their coding.
[CUSTOMER][NEUTRAL] Sorry, I don't know if I asked that correctly. OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If they lump it all together, it will be just one thing used if they break it down, we can use multiple benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. All right, well I will give, um, yeah, so sorry, last thing, are they good to call the.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The [PII] number that's fine and you guys can.
[AGENT][NEUTRAL] Yes, that
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that's the number here to APL and we'll be able to verify the benefits with them.
[CUSTOMER][POSITIVE] OK, sounds good. All right, well I'll give them a call and see if we can get this all settled and then um.
[CUSTOMER][NEUTRAL] Yeah, see what they can confirm.
[AGENT][NEUTRAL] OK, and I'm noting the policy for you now, so, um, this will be up here off if you do have to call back.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, and the number they should give is the policy certificate number and should they also share the medical ID number?
[AGENT][NEUTRAL] Um, no, the
[CUSTOMER][NEUTRAL] That was another thing that kind of got a little bit tricky, mhm.
[AGENT][NEUTRAL] So the policy certificate number is the only policy number that will apply to APL. The member ID, that number is really for 90 degree benefits. We can't really use that here in our system.
[CUSTOMER][NEUTRAL] OK, that's fine, but you guys will be able to support and say like hey this is what she has through 90 degrees. It's just you're not gonna be able to like do anything beyond that.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, no, we can't even really tell about 90 what 90 degree covers. All we can speak on is what our policy covers.
[AGENT][NEUTRAL] Which is the hospital indemnity part of it.
[CUSTOMER][NEUTRAL] OK, now I think I'm getting confused because that was another thing is that.
[CUSTOMER][NEUTRAL] When I, I, I talked to, I think two different people yesterday, they were saying that my OB stuff would be covered under 90 degrees.
[CUSTOMER][NEUTRAL] Or I could be I could be wrong on that.
[AGENT][NEUTRAL] Well, 90 degrees is just additional benefit, so it's not.
[AGENT][NEUTRAL] I mean, the, the reason I'm saying that is because like I can't go into the system and see what you have with 90 degrees, but I know 90 degrees is wellness benefits. So you with that D number, you will be able to call them and say, hey, what I do y'all cover for my APL policy, but I wouldn't be able to, I'm just saying I wouldn't be able to tell you, I can't see that. But for APL and the policy certificate number, we can give you the rundown on
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your hospital indemnity policy with us excluding the ninety-degree benefits part.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So when you call 90 Degree, you'll give them that number, that's their policy number basically and then the policy service for APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sorry, um.
[CUSTOMER][NEUTRAL] Yeah, I think I'm just I'm getting, um, I'm just getting different kind of mixed messages from your and and again not not this is nothing on you but like your team is telling me a few different things so right now if they if my.
[CUSTOMER][NEUTRAL] Insurance or sorry if my provider calls you guys, you guys can only share what is through the hospital indemnity.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But like what if through 90 degrees they also can cover some things well wellness wise and I apologies I didn't know that this is two separate things, yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, you're saying it right. So, yes, how you're explaining it to me is exactly what it is. So,
[CUSTOMER][NEUTRAL] So then, yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's like two companies working together. They have a part, we have a part, but I can't see their part, they can't see our part, but we know they're there.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, yes, you have those wellness benefits with 90 Degree and you have your policy with APL and it all works together, but APL is not going to be able to tell you, well, your 90-degree benefits does XYZ because we can't see it and they can't do it for us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, so to confirm through APL you guys can confirm that there is some sort of coverage because that's what I think happened yesterday is that my office called APL you guys say nope she's not covered.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] and then I'm told, oh this is through 90 degrees so I have the office call 90 Degrees and they're like, oh not covered so that's.
[CUSTOMER][NEUTRAL] I'm just afraid of that happening again but you but you're saying through APL you can see that there is some sort of coverage.
[AGENT][POSITIVE] Yes, you definitely have coverage.
[CUSTOMER][NEUTRAL] And you guys can give the green light. OK, OK, then, yeah, I then I don't really know what happened yesterday when they called you guys, um, and I'll, I'll triple check the 90 degrees. I, I would assume 90 degrees may not have truly doesn't have something for this, but um.
[CUSTOMER][NEUTRAL] OK yeah I will I'll call them, let them know, um.
[CUSTOMER][NEUTRAL] If there are any other issues I can call back and request uh if you don't mind I'll, I, I'll ask and see if you're available.
[AGENT][POSITIVE] Sure, that's no problem at all. And I'm, I'm noting the policy now too, so it's, it's gonna be there for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] All right. Well, was there anything else? OK.
[CUSTOMER][NEUTRAL] Um, and then I guess, sorry.
[CUSTOMER][NEUTRAL] Yeah, one more thing so.
[CUSTOMER][NEUTRAL] I guess this gets a little bit tricky so since I, let's just say you guys through APL can cover like a part of this and then 90 degree benefits actually can cover a part of this.
[CUSTOMER][NEUTRAL] Is there communication happening when billing comes through or would they have to bill it?
[CUSTOMER][POSITIVE] To APL and 90 degrees. I think that's gonna just curious, this is me just wanting to educate myself.
[AGENT][NEUTRAL] OK, wait, say that one more time. I want to make sure I understand what you're saying.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] So let's just say at some point they, you know, the my wellness comes in and they bill.
[CUSTOMER][NEUTRAL] Um, but 90 degrees actually does cover some sort of aspect of my wellness check, my women's wellness, and you guys can cover a part of it. Are you guys working together to make sure that's all being covered or?
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Is that a separate?
[AGENT][NEUTRAL] So, let me, let me see this. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, so when you, when a claim is filed, it's going to go to IMA. IMA does the repricing, so IMA is going to check with 90 Degree, they're going to check with us and see if there's any way that they can decrease the balance, and then it's sent to APL to continue processing.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Got you. OK. OK.
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] So IMA kind of bridges the gap between the two.
[CUSTOMER][POSITIVE] Got you alright, alright, that makes sense, yeah.
[CUSTOMER][NEUTRAL] Got you. Is there a con or a number for IMA? Because to be honest I've only known of APL, um, but yeah, is there a number of IMA that I can call if needed?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, um, let me know when you're ready.
[CUSTOMER][NEUTRAL] Do you have that?
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] So it's 800.
[AGENT][NEUTRAL] 833
[CUSTOMER][NEUTRAL] 800
[CUSTOMER][NEUTRAL] 833.
[AGENT][NEUTRAL] 4296.
[CUSTOMER][NEUTRAL] 4296.
[CUSTOMER][NEUTRAL] Hold on real quick. I just wanna see something.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think this answers one of my questions.
[CUSTOMER][NEUTRAL] Um, because I think the number that you're.
[CUSTOMER][NEUTRAL] Team member yesterday so I thought I had given them the 90 degrees number but actually that number sounds very familiar so.
[CUSTOMER][NEUTRAL] I and I don't know if you know but.
[CUSTOMER][NEGATIVE] Definitely called this number yesterday, the IMA number, and they told them that I have no coverage.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Would that make sense if they're the ones who have access to both?
[CUSTOMER][NEUTRAL] So sorry, I thought I'd given the number to 90 degrees, but uh it was actually the IMA number.
[AGENT][NEUTRAL] So you don't need to.
[AGENT][NEUTRAL] So that, yeah, that's not what they're for. So the IMA is not going to be able to tell you about your coverage. They're just simply repricing to see if they can bring your bills down.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh my God. OK, yeah.
[CUSTOMER][NEGATIVE] Gotcha. Gotcha.
[CUSTOMER][NEUTRAL] Just a question and I can find the number myself if needed. Do you happen to have the number to 90 degrees?
[AGENT][NEUTRAL] Yeah, hold on one second.
[CUSTOMER][NEUTRAL] Or no? OK.
[AGENT][NEUTRAL] I do, hold on one moment.
[CUSTOMER][POSITIVE] OK, this, no worries, this actually makes a lot more sense because I, this was the number that was given to me. I was under the understanding that it was 90 degrees, so now it makes sense why IMA was like, what are you talking about?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if if they're not able to give that information that makes sense.
[AGENT][NEUTRAL] Yeah, all they do is just they the claims are sent there, they do the repricing and then they send it to us to finish up.
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] Um, let me get the number for 90 degree. Hold on one second.
[AGENT][NEUTRAL] Wait, but 90 Degree and IMA has the same number. It's just different options.
[CUSTOMER][NEUTRAL] Oh, OK, and I, OK, you know what they did give me that. So number one was supposed to be 90 degrees. Is that, is that what you have in your record? OK, then never mind. So they did, they did call them.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Number one.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK, so same number they just have to select number one OK.
[CUSTOMER][POSITIVE] All right well I really appreciate it um we'll see like I said I'll call my provider, see what happens and um.
[CUSTOMER][NEUTRAL] I will let you know, uh, you know, I'll call back if there's any issues, but I'm hoping this should all be resolved.
[AGENT][NEUTRAL] Alrighty, well, so was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, I think I'm all set. I really appreciate it.
[AGENT][POSITIVE] You're very welcome. Well, thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too [PII] have a good one bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.