AccountId: 011433970860
ContactId: 63669685-8135-47b1-849e-f942bd672721
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444000 ms
Total Talk Time (AGENT): 139414 ms
Total Talk Time (CUSTOMER): 164075 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/63669685-8135-47b1-849e-f942bd672721_20250609T13:55_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. This is [PII] in the Midland Claims department. Um, I have a member on the line who's calling to get a further explanation of the denial of a couple of his claims for his hospital indemnity policy. Would you be able to further assist him?
[AGENT][NEUTRAL] Yes
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK, um, his policy.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, go ahead, sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02278594 for [PII].
[AGENT][POSITIVE] OK, perfect. Has he been verified?
[CUSTOMER][NEUTRAL] Yeah, he's been verified and his phone number is the number that's in the system.
[AGENT][POSITIVE] OK, perfect. OK, thank you so much, Evie.
[CUSTOMER][POSITIVE] OK, here he is. Thank you.
[AGENT][NEUTRAL] Hi, this is [PII] on the care team. How can I help you today?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII]. Um, I'm calling because uh I had received, um, two claims, uh.
[CUSTOMER][NEUTRAL] That were, I guess, um done the end of April, um, but I had received an email about a payment for one. So when I checked my quest portal, uh, for the other one, it's showing up that the second one, I guess that hasn't been fully processed yet, wasn't covered, um, but I know that all of the tests were just generic standard like routine, like a medical checkup, so it should be covered under like the Affordable Care Act, um, so I'm wondering if.
[CUSTOMER][NEUTRAL] That claim was processed incorrectly to the secondary insurance and not through the met coverage.
[AGENT][NEUTRAL] OK, uh, what was the date of service for that?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] the
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And you said that was for Quest diagnostics?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Because I see cause they did two, so there was one that was adjusted, but then the other one that like was the full panels of things that was like the $1,079. That one should be fully covered through the ACA.
[AGENT][NEUTRAL] Well, this is a, a supplemental hospital indemnity plan. Do you have another like major medical coverage or?
[CUSTOMER][NEUTRAL] Well, I said I thought that the next coverage, um, MBC coverage, um.
[CUSTOMER][NEGATIVE] Is the one that should have been billed instead of the indemnity plan.
[AGENT][NEUTRAL] Oh, OK. Um, yeah, under the hospital indemnity, we haven't covered it, but if you have a different coverage, I
[AGENT][NEUTRAL] You'd want to give them that information because what we have for you, we've got.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Under our plan, you have a hospital indemnity, group term life, dental and group accident. So if there's, if there's another coverage, the MEC coverage.
[AGENT][NEUTRAL] Um, it's not rendered, it's not guided by us, um, so I'm not sure who it would be through.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK, cause
[CUSTOMER][NEGATIVE] Cause it doesn't really give me a number for the Mac.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like to contact, uh, cause I thought that everything was gone through them first and then whatever was uh
[CUSTOMER][NEUTRAL] I guess not covered with was being sent to the
[CUSTOMER][NEUTRAL] The indemnity plan.
[AGENT][NEUTRAL] We took the claim that we received.
[CUSTOMER][NEUTRAL] Because it's all it's
[CUSTOMER][NEUTRAL] Cause it's all on like one card.
[AGENT][NEUTRAL] OK, let me pull up your ID card and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's
[AGENT][NEUTRAL] OK, so it looks like, let's see you've got.
[AGENT][NEUTRAL] The limited hospital indemnity.
[AGENT][NEUTRAL] There is a
[AGENT][NEUTRAL] There is a benefit under 90 degree benefits.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That one
[AGENT][NEUTRAL] Might be what you're thinking of.
[CUSTOMER][NEUTRAL] Today.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I think that one is it.
[AGENT][NEUTRAL] Yeah, this is the, um, there's a medical ID on the front of your card. It's real small, it's towards the bottom and it starts with [PII].
[CUSTOMER][NEUTRAL] Yeah, so it's, yeah, I have that number, I think.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I think that might be what.
[CUSTOMER][NEUTRAL] Is it the
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Correct, so that's the only number that I've been giving people and that's what they keep putting in, but for some reason.
[CUSTOMER][NEUTRAL] I, I guess it's just bypassing.
[CUSTOMER][NEUTRAL] The Mac coverage and I don't know why.
[AGENT][NEUTRAL] Um, I can get you transferred over to 90 Degree, um, to see if they have a different solution of how to submit the claim, but this is where they should submit them and then we process accordingly, but for that specific plan, that medical ID, we don't do the um coverage, but you'll see there's a policy cert number that's for your limited hospital indemnity plan.
[AGENT][NEUTRAL] And if they send it to that, then that's, that's what we process under.
[CUSTOMER][NEUTRAL] OK, so the, the group indemnity is the one that ends in 94.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so yeah, if you wouldn't mind transferring me to 90 degrees, that would be great and then what is their, their number?
[AGENT][NEUTRAL] Um, their number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for