AccountId: 011433970860
ContactId: 8c1244a1-9650-4554-ad7c-7c081e60d6f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1085760 ms
Total Talk Time (AGENT): 195787 ms
Total Talk Time (CUSTOMER): 302252 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/8c1244a1-9650-4554-ad7c-7c081e60d6f2_20250128T14:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I have a, um, I believe it's like a hos I don't know what you call it, but it's a hospital plan where if you go in, they'll help you cover the cost your insurance didn't cover. OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and, but I went to the hospital and uh, I amassed myself a nice bill.
[CUSTOMER][NEUTRAL] Um, but it was for a condition I've had for, I've known I've had for 3 years, and I've only been signed up with you all for
[CUSTOMER][NEUTRAL] Uh, less than a year.
[CUSTOMER][NEUTRAL] And so if we're reading this properly, I don't think I qualify for a benefit as it would be a pre-existing condition. We're trying to figure out whether uh we ought to do this paperwork or not.
[AGENT][POSITIVE] Oh OK, yes, I can assist you with that. And may I have a callback number just in case we get disconnected and the policy number?
[CUSTOMER][NEUTRAL] You sure can. As soon as I, well, let me give you one. It's not this number because I just got a new cell phone. I don't know the number but I'll give you my old cell phone number. I'm carrying about [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so if we get disconnected I can call you to that number?
[CUSTOMER][NEUTRAL] Yeah, you can it's sitting right beside me.
[AGENT][NEUTRAL] [PII]. OK, perfect, thank you. Alright, and may I have the policy number if you haven't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I might let me look, OK.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I don't, I have an [PII] license.
[CUSTOMER][NEUTRAL] But I don't know what that means a [PII] or an [PII] license, but I don't know what that means.
[CUSTOMER][NEUTRAL] Um, I guess it's your's license it must be based.
[CUSTOMER][NEUTRAL] I don't really know.
[CUSTOMER][NEUTRAL] Um, no, I don't have a policy number. This was an employee benefit to me by my firm, and, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I don't have a policy number. I apologize.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah that's fine, um, let me do a name search one moment.
[CUSTOMER][NEUTRAL] Yeah, look for someone with like an oversized head on a normal body.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't think that's gonna be described on the name.
[CUSTOMER][NEUTRAL] I did. I got
[CUSTOMER][NEUTRAL] Yeah, I got a [PII] guy's head and a [PII] guy's body. I, there was a, there was a clear overage and shortage of parts when I got made.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, um, may I have the spelling of your last name just to make sure I spell it correctly for the system.
[CUSTOMER][POSITIVE] Absolutely, [PII]
[AGENT][NEUTRAL] OK and the spelling of your first name?
[CUSTOMER][NEUTRAL] Uh, it's either [PII] or [PII] would be [PII] I'd probably go by [PII]. I'm not sure how they did it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, maybe it's on this email.
[CUSTOMER][NEUTRAL] Um, [PII] is how it says on this email from [PII].
[AGENT][NEUTRAL] OK, um, so [PII]?
[CUSTOMER][NEUTRAL] [PII]? Yes, ma'am. I can give you a date of birth or social, whatever you need.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me try, uh, OK, let me try [PII] if it doesn't work I try [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, what is the address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] And work is uh Newton Financial Group [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] used to be 2B, [PII].
[AGENT][NEUTRAL] OK, let's try [PII] and.
[CUSTOMER][NEUTRAL] I've been there so long I know the history of the roads.
[AGENT][NEUTRAL] Mhm OK
[AGENT][NEUTRAL] Alright, OK, I think I found you. Um, may I have your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, OK, thank you.
[AGENT][NEUTRAL] And the email address on file for verification.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] but that needs to be updated because Apple doesn't support [PII], that's an old one to [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it's gonna be the same one just iCloud?
[CUSTOMER][NEUTRAL] Yes, it's the same it's just me and iCloud will get there to most systems but they're starting to be systems where me doesn't make it.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK. And can you repeat that one more time? I, I erase the whole thing.
[CUSTOMER][NEGATIVE] I found it, the one that didn't work.
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[CUSTOMER][NEUTRAL] [PII] is the better use of that email address.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But if you need to, you can send it to [PII] and I'll get it, but Apple's closing out that old platform.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I, I went ahead and update it.
[AGENT][NEUTRAL] OK, so it is updated. You're welcome.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so let me check the elimination period on this one, and what is the date of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the last one was just 3 weeks ago, so I, it's between November and 3 weeks ago, I had, uh, 4 procedures.
[CUSTOMER][NEUTRAL] The last couple of months, the last 3 months.
[AGENT][NEUTRAL] OK, so before that, did you have anything else? Um
[CUSTOMER][NEUTRAL] Yeah, yeah, I have, I've been dealing with this for years, for 3 years, which is why it might be a pre-existing and not qualified, um.
[AGENT][NEUTRAL] 3 years.
[CUSTOMER][NEUTRAL] I've had doctor's visits waiting on the FDA, all sorts of things like that for the last 3 years regarding this heart valve.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me go ahead. Mhm.
[CUSTOMER][NEUTRAL] So there's no arguing that I had it before I got the policy. I just got to [PII] and got picked up this insurance with you all, uh, I think last fall.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Got you. OK. Yeah, let me go ahead and go over the paperwork and see what is the limitations of the policy and see what is the elimination period, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Mr. [PII].
[CUSTOMER][POSITIVE] Sure. Yeah, I need your help, so thank you for helping me.
[AGENT][NEUTRAL] OK. Um, you're welcome. OK, so I'm looking at the documents of the policy and I went over all the benefits and everything on it. And under preexisting um period, it says 0, so there's no preexisting.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For this one.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, that would be great. Uh, would you be so would you be able to email me that so I can reference it when I do this, uh, claim form?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Um sure.
[CUSTOMER][NEUTRAL] Does it ask for like the policy numbers and stuff, and I did this in the middle of transition over to [PII], and I'm not sure I could find the clothes I wore during those six months.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Uh, it was terrible.
[AGENT][NEUTRAL] Understand. Yeah, I'm gonna go ahead and send the certificate information which has all the information of the policy, including what's covered, what's not covered, how much it covers, and on page 6, I believe is where you're gonna see that um.
[CUSTOMER][NEGATIVE] It was terrible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Pre-existing condition period, OK? And it does say 0, so yeah, that means that there's none and I went through the policy and I don't see anything, so that means there's nothing there. OK, uh let me go ahead and send this out right now, if you don't mind.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] Let me convert it really quick. OK, one moment.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, you wanna check in and see if you got it?
[CUSTOMER][POSITIVE] Yeah, I did. That's a great take care.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Not yet.
[CUSTOMER][NEUTRAL] It was gonna go to [PII] or [PII].
[AGENT][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, yes, let me, uh.
[CUSTOMER][POSITIVE] Let me check junk, OK? Cause if it's got anything with it, they get all terribly excited. Oh, no, came from the care team there at APL and it has an attachment and that is fabulous. Thank you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, but that's been great. I do appreciate the help thank you.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] You're welcome and you have a good day. Thank you for calling ATL.
[CUSTOMER][POSITIVE] All right, bye-bye. All right, thank you. Bye bye now.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] About that you
[CUSTOMER][NEUTRAL] So what did she say?
[CUSTOMER][NEUTRAL] That I have no exclusion