After No
Urgent help
Menu Close
Part of: Build your case

Guide · the basics · 5 minute read

How to talk to your insurer on the phone

Call habits that protect you, such as getting names and reference numbers and asking for it in writing, and what a phone call can and cannot do. Links to phone scripts for common calls after a denial.

Applies to: Any coverage

Key points

  • Before you call, have your member number, claim number, denial notice and deadline in front of you, and decide the one thing you want from the call.
  • Ask for the person's name and a reference number at the start, repeat back what you were told, and ask for anything important in writing.
  • A phone call is usually not an appeal. Put your appeal in writing, unless the claim is urgent, in which case an appeal may be made orally or in writing.
  • Write the call in your log and follow up in writing.
On this page 7

A phone call can fix a simple error, tell you where to send a request, or get you a reference number. It rarely replaces a letter. Call with one goal, get the person’s name and a reference number, write down what you are told, ask for anything important in writing, and follow up with a short note.

What this means

The person who answers may not be the person who decided your claim, and may not be able to change a medical decision. They can often look up the status, explain a code and tell you where to send things. Ask what they can do on this call.

Patient advocates give the same advice: ask the plan for a “ticket number”, keep notes, and do not rely on a phone call as your appeal. The Patient Advocate Foundation advises gathering evidence and writing it up rather than appealing by phone on the first call. KFF Health News, a health policy newsroom, lists asking for a ticket number among its tips.

What to do

  1. Get ready (your step). Have your member number, claim number, date of service, the denial notice and your deadline in front of you. Open your call log.
  2. Decide the one thing you want. For example: the status of a claim, where to send an appeal, a reprocessing, the clinical criteria, or a peer-to-peer review.
  3. Start with the basics. Say your name and claim number. Ask: “May I have your name, and a reference number for this call?” Write both down.
  4. State your request briefly. One or two sentences. Use the script that matches your call (see below).
  5. Ask what happens next. “What is the next step, who does it, and by what date?” Write down the answer.
  6. Ask for it in writing. If you are told something important, such as a decision, a deadline or a reason, say: “Please send that to me in writing, or tell me where I can ask for it in writing.”
  7. Repeat it back. “Let me read back what I have.” Correct anything wrong while you are still on the line.
  8. End with a date. “If I have not heard by [date], I will call back.” Write it down.
  9. Follow up in writing. Send a short note the same day: who you spoke to, when, what they said and what you expect. Keep proof you sent it. See how to keep a call log and paper trail.

Scripts for common calls

Each script gives you the words, the questions to ask and what to write down:

The call script builder fills in your details. The insurer phone call checklist is a one-page reminder to keep by the phone.

What the person may say, and what to say back

“I can’t put that in writing.” Ask where a written request goes, and send one. Write down the name of the person who told you.

“That is the final decision.” Ask them to tell you in writing, and ask how to appeal. The denial notice must describe the review procedures and time limits.

“You can appeal by phone.” For a claim that is not urgent, still send a written appeal. If the care is urgent, an appeal may be made orally or in writing. Ask for a reference number either way.

“I’ll transfer you.” Before the transfer, get the new department’s name and a direct number, and ask them to note why you are calling.

The rule

An urgent appeal may be requested orally or in writing, and information may move between the plan and the claimant by telephone, fax or a similarly fast method. See section 2560.503-1(h)(3)(vi) of Title 29 of the Code of Federal Regulations (CFR): 29 CFR 2560.503-1.

Watch for

  • Asking for codes is not an appeal. If you ask for the diagnosis and treatment codes and their meanings, the plan cannot treat that request as filing an appeal or an external review request. Keep your appeal deadline in view anyway.
  • Someone else calling for you. A plan must let an authorized representative act for you. If a relative or helper will call, name them first. See name someone to act for you and how to act for someone else.
  • Language help. Ask for an interpreter. In counties where 10 percent or more of the people are literate only in the same non-English language, the plan must provide oral help in that language. Other plans may offer it too.
  • Do not agree on the spot. If you are asked to withdraw, accept a new bill or drop a request, ask for it in writing and say you will reply after you have read it.
  • Your deadline. The plan must give you at least 180 days after you receive the denial notice to appeal, and your plan may allow more. Check the date on your notice, which controls.

What next

Sources

Official and primary sources used on this page. Checked 2026-11-12.

  1. 29 CFR 2560.503-1, claims procedure — Electronic Code of Federal Regulations
  2. 29 CFR 2590.715-2719, internal claims and appeals and external review for non-grandfathered group plans — Electronic Code of Federal Regulations
  3. Engaging with Insurers, Appealing a Denial — Patient Advocate Foundation
  4. Fighting a Health Insurance Denial? Here Are 7 Tips To Help — KFF Health News

What next

Letters and scripts

Tools

  • Tool

    Call script builder

    Get the words to say, what to ask for and what to write down before you phone your plan or provider.

  • Tool

    Call log

    Record every call: the date, who you spoke to, the reference number and what was promised.

  • Tool

    Authorized representative helper

    See what permission you need to act for someone else and build the letter that names you.

Checklists

  • Checklist

    Phone call with your insurer

    What to have ready, what to ask and what to write down on a call with your plan, so the call leaves a record.

Related guides

  • Guide

    How to keep a call log and paper trail

    Record every call, letter and message with your plan and providers, with names, dates and reference numbers, so you can prove what was said and keep your deadlines straight. Includes a simple log you can copy.

  • Guide

    The first 48 hours after a denial

    A calm list of what to do, and what to hold off on, in the first two days after a health plan says no to care, a drug or a claim.

  • Guide

    Before you appeal: corrected claims and reprocessing

    When a denial comes from a paperwork mistake, a corrected claim or a reprocessing request may fix it faster than an appeal. Here is how to try that safely without losing your appeal deadline.

  • Guide

    Peer-to-peer review and how to prepare your doctor

    A peer-to-peer review is a phone call between your doctor and the plan's reviewing doctor. It is usually worth asking for early, but availability and timing vary by plan. Here is how to ask and prepare.

  • Guide

    When the insurer misses its deadline or goes silent

    If your plan does not decide your claim or appeal on time, you may be able to skip ahead to external review or court. Here is what the rule says, its small-mistake exception, and what to do in practice.

  • Guide

    Prior authorization stuck

    What to do when your plan has not answered a prior authorization request, how long each type of plan has, and how to push a stalled request forward.

  • Guide

    Acting for someone else

    You can usually help a parent, partner or adult child with a denial if they give written permission. Here is how to name a representative with plans, Medicare and Medicaid, and what this page does not cover.

  • Guide

    How to file a complaint with your state insurance department

    A complaint tells your state insurance department that your insurer broke a rule. Learn when it works, who it cannot help, what to send, and why it does not replace your appeal.

This page is general information, not legal or medical advice. Your notice, your plan document and the law that applies to your coverage control.

Sources last checked . Found a mistake? Report it.