Phone script: three-way call with your provider
How to bring your doctor's office onto a call with your plan so that both sides hear the same facts and agree on what happens next.
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- A template, not legal advice
When to use this, and what it is not
When to use this. When the plan says it is missing information, or your provider's office can explain the need for care better than you can. Agree a day and time with the provider's office first, and ask it to have your records and the denial letter ready.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the script
Your script
Date of this call: [Date of the call] 1. Call the plan's member services number. Say: "I am [Your name], member identification (ID) number [Member ID], calling about claim [Claim or reference number]. I would like to add my provider's office to this call." 2. Ask for the person's name and a call reference number. Ask whether the call may be recorded, and write down their answer. 3. If you agree to it, say: "I give permission for you to speak with [Name of the person at your provider's office] at [Doctor, hospital or pharmacy] about this claim." 4. Ask: "Does the plan need a signed form before my provider can act for me, for example in an appeal?" 5. Say: "Please bring [Name of the person at your provider's office] onto the line at [The provider's office phone number]." 6. Ask the provider's staff to explain, in their own words, why the care is needed. 7. Ask the plan: "What exactly is missing or unclear in the file? What would change the decision?" 8. Ask: "Can a peer-to-peer review happen today?" 9. Ask: "What will each of us send, to whom, and by what date?" 10. Write down: names, ID numbers, date, time, reference number, and each promised action with its date. 11. Close: read the list back and ask, "Is that right?" Ask the plan to note on the file that the provider joined at your request. Say, "Thank you."
Before you call
Call the member services number on the back of your insurance card. Ask for a call reference number at the start and again at the end of the call. Have the provider's office phone number ready before you call.
What happens next
- Send a short written summary of what was agreed to the plan and to the provider's office the same day.
- Job-based and individual plans must let an authorized representative act for you. In an urgent case they must let a health care professional who knows your condition act as your representative. In a Medicare Advantage plan, a treating physician may ask for a decision after telling you. Ask the plan for its form.
- Call back on the date the plan promised. If nothing has happened, use the script for an appeal that has gone silent.