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Before you call
Have your member ID, the facility's name, and dates of service ready before you dial.
Why this guide exists
The answer depends on who picks up
Call your insurance company twice about the same claim and you can get two different answers — not because anyone is lying to you, but because benefits, authorizations, and appeals are handled by different people reading the same policy differently. The families who get the best outcomes aren't the ones who found the "right" person on the first try. They're the ones who wrote everything down, every time, so they had a paper trail when it mattered.
This guide is built around that habit: a repeatable call log, the questions worth asking whether it's your first call or your fifth, and a clear-eyed list of what to ask if you're told no.
This isn't one phone call
It's a series of calls, over weeks or months
Prior authorization, concurrent review, single-case agreements, appeals — each one is its own call, often with its own department and its own rep. Without a log, it's easy to lose track of who told you what, and easy for the burden of proof to quietly shift back onto you.
This guide can't make the process faster. It can make sure you have a record good enough to point back to when someone says "we never told you that."
What to ask on every call
Questions worth repeating each time
Rep Name & Reference NumberEvery call, every time — get a name, an ID or badge number if offered, and a reference number for the call itself.
Prior Authorization StatusIs this level of care authorized, for how many days, and what specifically needs to happen for it to continue?
In-Network vs. Out-of-NetworkIs this facility in-network, and if not, is a single-case agreement possible — and who initiates it?
Concurrent Review ScheduleWhen is the next review, what information will they need, and who's submitting it — you, or the facility?
Peer-to-Peer ReviewIf something is denied, can the treating provider request a peer-to-peer review with the insurer's medical director?
Appeal Rights & DeadlinesIf denied, what's the exact appeal deadline, and is expedited appeal available given the circumstances?
If they say no
What to ask when the answer is a denial
A denial is rarely the end of the conversation — it's the start of a different one. Ask these before you hang up:
- What is the specific reason for the denial, in writing — "not medically necessary" is not specific enough; ask what criteria weren't met.
- What is the internal appeal deadline, and does it differ from the external/state appeal deadline?
- Can we request an expedited appeal given the clinical situation, and what makes a case eligible for that?
- Can the treating provider speak directly to the insurer's reviewing physician (peer-to-peer), and how is that scheduled?
- What supporting documentation would most directly address the stated reason for denial?
- Is there a state department of insurance or ombudsman we can involve if the internal appeal is also denied?
Quick tip
Log every call, not just the important ones
The call that seemed routine is the one you'll need later
It's tempting to only write things down when a call feels significant. In practice, the routine "just checking in" call is often the one where a rep says something in passing — a date, a name, a requirement — that turns out to matter later. Log the date, the rep, the reference number, and what was said, every time.
This guide's call log is fillable and printable, and it saves in your own browser as you go — no account, nothing sent anywhere. Once care is underway, use the Intake & Placement Tracker alongside it to keep the clinical side and the insurance side in one place.
How to use this
Before, during, and after each call
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During the call
Get the rep's name and a reference number immediately — before you get into the substance of the call.
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Ask the standing questions
Work through the questions above every time, even if you think you already know the answer.
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Log it right after
Write down what was said while it's fresh — five minutes later, not five hours later.
Questions
Before you begin
Is this legal or insurance advice?
No. This is general guidance based on lived experience and common patterns families run into — it is not legal, medical, or insurance advice. Always confirm your specific plan's terms, deadlines, and appeal rights directly with your insurer and, where needed, an attorney or patient advocate.
Do I need to log every single call?
Ideally yes, even short ones. A denial or dispute often comes down to "who said what and when" — a consistent log is the easiest way to have that answer ready.
What if my plan is self-funded through my employer?
Self-funded plans (ERISA plans) can have different appeal rules than fully-insured plans. If you're not sure which you have, ask your employer's HR or benefits department, and ask your insurer directly — it changes your appeal options.
Where is my information stored?
Everything you type stays in your own device's browser storage — nothing is sent to a server. Use "Download Backup" in the call log's toolbar to save a copy you control.
Can I print it?
Yes. Use "Print / Save PDF" in the call log's toolbar for a paper or PDF copy for your binder, with space to write in your own notes.
Free to use
Get the name. Get the reference number. Write it down.
Open the call log before your next call with insurance, and keep using it every time — routine call or not.
This guide is general information based on lived experience, not legal, medical, or insurance advice. Confirm your specific plan's terms, deadlines, and appeal rights directly with your insurer.