AccountId: 011433970860
ContactId: 85cbee60-cee6-4066-b1a4-221eb7938f26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 572159 ms
Total Talk Time (AGENT): 151521 ms
Total Talk Time (CUSTOMER): 116190 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/85cbee60-cee6-4066-b1a4-221eb7938f26_20250520T21:07_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How you doing?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm doing good. Um, I have a provider on the other line. They received a payment from us and then later a letter requesting it back, saying that their provider isn't a physician, it's a chiropractor. Um, can I give you the policy number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 234.
[CUSTOMER][NEUTRAL] 88888.
[CUSTOMER][NEUTRAL] The original claim is the 356-6792. This is for part two.
[CUSTOMER][NEUTRAL] And then the one that we asked for it back is ending in 8222.
[AGENT][NEGATIVE] And we mailed a letter asking them to to send a refund to us.
[CUSTOMER][NEUTRAL] It looks like it was on the EOB because I pulled up the remark code and it said what she said but she said it was a letter.
[AGENT][NEUTRAL] Give me one second, I pull up the EOV.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The refund request letter is under 8199. OK.
[AGENT][NEUTRAL] And what is she wanting? What is, what is her question?
[CUSTOMER][NEUTRAL] So they wanted to know why was it, um, why are we asking for the refund and how are we determining that their doc their physician isn't a physician?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, you can send her on over.
[CUSTOMER][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Hello [PII], yes, thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK? Thank you. You're welcome.
[AGENT][NEUTRAL] Hello
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm with Marshall Chiropractic Life Center. Uh, we have a patient, [PII], that when we called and checked his benefits we were told he had 4 chiropractic visits a year, um, and so he had a visit on [PII] and we sent the claim and they originally paid it.
[CUSTOMER][NEGATIVE] But then I received a letter today requesting a refund back to you guys saying that we're not licensed to practice medicine within the scope um so I don't understand.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one second, I was pulling up this policy to see what their definition.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Of uh position is one moment.
[AGENT][NEUTRAL] Bear with me one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So his policy just says the same thing, uh, it it says on the letter a practitioner of the healing art who's legally qualified. So let me just make sure that.
[AGENT][NEGATIVE] It doesn't cover maybe chiropractic services are not covered.
[CUSTOMER][NEUTRAL] That's what the other woman was saying but she wasn't sure.
[AGENT][NEUTRAL] And that it that it has to be uh.
[AGENT][NEUTRAL] Yeah, I'm double checking that just to make sure before I get with the examiner.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] OK, so physician's office.
[AGENT][NEUTRAL] OK, can I put you on hold just one second?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][POSITIVE] All right thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, [PII], I have a question.
[AGENT][NEUTRAL] On the HI [PII].
[AGENT][NEUTRAL] Um, if
[AGENT][NEUTRAL] So with the office visit is only for like medical doctors, so it doesn't pay for chiropractic services, is that correct?
[AGENT][NEUTRAL] Right, um
[AGENT][NEUTRAL] Apparently um you have.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] and
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] About the
[AGENT][NEUTRAL] Yeah, is that, and then we requested a refund of money that we'd already paid out to them.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yeah, so that's my understanding.
[AGENT][NEUTRAL] So that going forward that.
[AGENT][POSITIVE] It better um chiropractic.
[AGENT][NEUTRAL] They
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, alright, sounds good. I just want to give her the correct information.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you for holding. OK, so, uh, according to their policy, uh, chiropractor does not meet the definition of a physician.
[AGENT][NEUTRAL] Um, so the basically it's like there.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Policy only covers like sick offices when they go to like a medical doctor for uh actual sickness, not chiropractic services, even though I know that is, you know, there's something going on with that but it's more uh along the lines of like for a medical doctor.
[CUSTOMER][NEUTRAL] OK, I will let the.
[CUSTOMER][NEUTRAL] Doctor, no and the patient no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, was there anything else I can help you with on today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] Alrighty thanks and have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.