AccountId: 011433970860
ContactId: f1b3d2f8-2961-467f-88fe-b297b0a3af20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745900 ms
Total Talk Time (AGENT): 357359 ms
Total Talk Time (CUSTOMER): 471263 ms
Interruptions: 19
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/f1b3d2f8-2961-467f-88fe-b297b0a3af20_20250509T14:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], I'm [PII] with Mount Carmel. Can we look at a claim together that we've submitted to you?
[AGENT][NEUTRAL] OK [PII], you're wanting claim status, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and what is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] The member's policy number is shown as D as in Desiree, 47680701.
[AGENT][NEUTRAL] OK, thank you. Now [PII], that is a 90 degree benefit number, not an APL policy number. Were you trying to reach 90 degree benefits or APL?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I'm looking at what's in my system and I have it being a commercial generic. Now it says contact benefits in the letter A card and I have this phone number but I don't have a another.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Phone number and I was looking to see who worked the claim before me. It says that because I wasn't me no one of my coworkers got a hold of 90 degree Benefit the website, and he said it didn't appear on file, so he called this number and got a recording saying the office was closed prior to that a coworker of mine.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Her review account just worked there's no claim when there was no claim on file and it was resubmitted back in March, so I'm just kinda going by what I see here and I just called the number, yeah, because this is secondary this would be the secondary Oscar paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was
[AGENT][NEUTRAL] So you have
[AGENT][NEUTRAL] OK, so let's see here [PII], so you called [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so when you call that phone number, depending on which option you select as to where it takes you, that D number indicates it's a 90 degree policy, so that would be option 1.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] APL is, I'm not sure which option, but it's a different option on their on their um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Automated system.
[CUSTOMER][NEUTRAL] I thought the APL said option two. I don't know, but uh it it was kind of confusing because it generally would say claims and you know I'm, I'm doing a report and trying to help get caught up on some of these claims so I'm not real familiar with APL or all of that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, sure. Well, I'll tell you what, why don't we do this?
[AGENT][NEUTRAL] OK, so why don't we do this? Because some of those members, like I said, can have dual coverage, and some of them only either have 90 degree benefits or APL. So the D number definitely indicates there was a 90 degree policy at some point. Do you have any other information that I can try and look up the member with? Do you happen to have the full social for the subscriber on the policy?
[CUSTOMER][NEUTRAL] Mhm, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm sure I do. I'm looking at my system and when they come we load it as it is, so you tell me what you need and I'll get there and give it to you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. If you have the full social for the subscriber, that's what I need.
[CUSTOMER][NEUTRAL] Alright, let's find that. Let me go into the demographics. I'm telling you these accounts I'm like really? it's just it's harder, you know, to get through to anyone to try to get the claims paid and processed, so, OK, you ready?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes ma'am, I am.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's for [PII]. Mhm. Go ahead, I'm sorry.
[AGENT][NEUTRAL] OK, so that was [PII].
[AGENT][NEUTRAL] OK. So did you say [PII]?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK. All right. Just one moment. Let's see. OK, so with that social, You're welcome. So with that social, there is no one in our system by that social. Now, I can try the last, I can try by the name, I just can't search my date of birth. So again, what was the last name?
[CUSTOMER][POSITIVE] Yes. All right. Any help would be appreciated. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. First name?
[CUSTOMER][NEUTRAL] The first name is spelled [PII] and I'm showing a middle initial of the letter [PII]
[AGENT][NEUTRAL] OK, so we'll just try the name and then that's gonna kinda rule out if I can't locate anything in our system and I can get you connected back over to 90 degree benefits and again, you did call the right number, but if for any reason our phone call were to get disconnected during the transfer, just select option one when you call back if you have to. All right, so just.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, because I did select option 2. I did, [PII]. I selected option 2 because I, and you know what? That's funny you said that because I let it, I, I repeated it again cause it says press star if you want because I wasn't sure, you know, I wasn't sure and I'm like I'm, I'm gonna pick the wrong option, oh Lord.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. Well, that's OK.
[AGENT][NEUTRAL] Well, you're fine. So we're just trying to sort out to make sure that you're not talking with someone you need to be, but I do not have anyone in our system either, Desiree, by that name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] All right, so I can get you connected over. Yeah.
[CUSTOMER][NEUTRAL] All right then, and we'll try.
[CUSTOMER][POSITIVE] OK. OK. Thanks for your time, [PII].
[AGENT][NEUTRAL] But before I do that.
[AGENT][POSITIVE] Oh, you're very welcome. It was my pleasure. Is there anything else I could try and help you with before I connect you with 90 Degree benefits?
[CUSTOMER][POSITIVE] No, I'm just, no, you've already helped. Thank you again. I really appreciate it.
[AGENT][POSITIVE] Well, you're certainly very welcome and I hope you have a wonderful weekend and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yes, ma'am. You do the same.
[AGENT][POSITIVE] Thank you so much. So one moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree. If you would like to participate in a quick, we're sorry, but all agents are currently unable to take your call. Please leave a detailed message after the beep and we will get back to you as soon.
[AGENT][NEUTRAL] OK, [PII], it is giving me a message saying that they all their representatives are currently, you know, on another call or whatever at the moment and it's asking to leave a voicemail, but I just did not want to drop you into their voicemail. Mm. So I didn't want to just release you into that without telling you, but I can either transfer you back over so you can leave a message or if you just wanna try back, it's, I'll be happy to.
[CUSTOMER][POSITIVE] Yeah, I've been doing that all yes girl, OK, alright.
[AGENT][NEUTRAL] You know, whatever you would like to do.
[CUSTOMER][NEUTRAL] Yeah, I wanted to, I wanted to tell you what I, I was playing around and looking at some things. Now as far as the secondary, see on the card, it doesn't even identify to me, you know, like you were saying the APL or the other. What I see is a Cigna Healthcare card and then it says EC I guess this is OLA Carelink member and it has a total different.
[CUSTOMER][NEUTRAL] Uh, ID number on here then, you know, well, we, we went over the Social Security, the number and then I have a different number of [PII].
[AGENT][NEUTRAL] Oh, I don't know what that number is. Yeah, I don't know what.
[CUSTOMER][NEUTRAL] So I don't know. Yes, girl, did see, that's what I'm saying. And then when they come, we're supposed to, yes, we're supposed to get the insurance card scanned, but you know that's what I'm saying. I didn't see a generic uh commercial insurance card scanned under by the name of benefits in a card. I ain't never heard of that. So I just.
[AGENT][NEUTRAL] I don't know about any of that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Actually, OK, well, OK. So benefits in a card is like a third-party administrator, and these different agencies, their employees enroll through benefits and a card for different types of coverage and then benefits and a card provide enrollment information to the companies, you know, for that specific product. So for like,
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] APL for a lot of the, we do work with benefits and a card and for their groups, we, our plans are typically either dental policies or limited benefit hospital indemnity type plans.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 90 degree benefits has, you know,
[CUSTOMER][NEUTRAL] And see, that's what I was looking. I was, I think I selected the indemnity plan option.
[AGENT][NEUTRAL] And that's us, but the member doesn't have an indemnity plan with us. Mhm. Yeah, so, so they don't have.
[CUSTOMER][NEUTRAL] And I looked, yeah.
[CUSTOMER][NEUTRAL] OK, so if I have a second, can you check another member ID because I'm showing Cigna PPO on another card and it's a, it's a total different ID number.
[AGENT][NEUTRAL] Now we
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Now, if it's a Cigna number, no, I won't be able to check that.
[AGENT][NEUTRAL] It would have, I can only check APL policy numbers like we just did, um, on the [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And the AP, yeah.
[CUSTOMER][NEUTRAL] Uh-huh. It's the same person, but I'm just saying I see three options. I see [PII], select, and I see Cigna, and I see the benefits and a card, and that's the number that I gave you because I'm showing that you would be my supplemental where we submitted the claim, you know, as secondary.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that would be the 90, that Dean.
[CUSTOMER][NEUTRAL] And I'm showing here that my coworker.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Yeah, 90 degree benefit. That's what [PII] put in here, and he checked the website, but he get the same results like the patient does doesn't exist. There's nothing there. That's why I was calling today because we either way, you know, we're not getting anything, but I tell you what, I'm gonna make a self pay and get the patient involved and they can call us back with the correct information because I don't have time to play inspector gadget with everybody's claim.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] So that's what we do, but, but you know I'm telling you it it's frustrating and then like I said for me, I'm corporate I'm not at the hospital but they need to make sure they, they scan the correct card information so that way when we have to follow up and collect on this 20% balance for the patient, we can get a hold of the right people. So the number where you were transferring me to.
[AGENT][NEUTRAL] I unders.
[AGENT][NEUTRAL] Yeah I know.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] At
[AGENT][NEUTRAL] Uh-huh, uh-huh.
[CUSTOMER][NEUTRAL] It, you said you did say I dialed the right number, right?
[AGENT][NEUTRAL] That [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, can you just transfer me and then I'll select the option to leave the message if necessary, pretty please, OK.
[AGENT][NEUTRAL] But options.
[AGENT][NEUTRAL] Yeah. Yeah, I'll do that. And again, it's option one to get you to the ninety-degree benefits. But yes, ma'am, I'll just go ahead and, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let me ask you
[CUSTOMER][NEUTRAL] And put me over. OK, I was just gonna say, uh, since we've been on this call 14 minutes and 34 seconds, can you give me a reference number?
[AGENT][NEUTRAL] Yes, ma'am. You used my name [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, well, I'll use your name, [PII] and 5925 and you have a good day. Thanks again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Oh, absolutely. And again, it was my pleasure. So give me one moment and I will, I'll just transfer you and release the call so that you can hear that full recording.
[CUSTOMER][NEUTRAL] And mine too.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Alright. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][POSITIVE] Thank you for calling. If you would like to participate in a.