What to say: every script in one place

I'd like to request an itemized bill with the billing codes. I'm not refusing to pay; I'm asking for a bill I can verify.

Say it calmly to the billing office on the bill, and ask them to note in your file that you called today.

I'd like to request an itemized bill with the billing codes for my visit on [date]. Can you note in my file that I called today?

If they ask why, you can say: I want to check it against my Explanation of Benefits, the statement my insurer sent me.

Can you tell me how much of my deductible I've met this year, and on what date it resets?

Ask your insurer's member services line, the number on the back of your insurance card.

Can you tell me which provider this bill is from, whether they were in my network, and which claim number it matches on my insurer's side?

Ask the billing office named on each bill; they are often different offices, even for the same visit.

My EOB shows I owe a different amount than your bill. Can you tell me the exact reason for the difference, and please send me a corrected bill in writing?

Have both documents in front of you, with the claim number and the date of service.

I want to resolve this bill. Do you offer a discount for paying in full, or a financial assistance program I could apply for? Please send me whatever we agree on in writing.

Ask the billing office or patient financial services, not a collections agency.

I'd like to apply for financial assistance under your policy. Can you send me the application and put a hold on this account while it's reviewed?

You can ask even if you have insurance, and even after you have started paying.

I believe this is a surprise bill covered by the No Surprises Act. I'm asking you to bill my insurer at the in-network rate and to send me that in writing.

Say it to the doctor's billing office, and tell your insurer the same day.

I'm disputing this debt and requesting written verification, including the original provider, the date of service, and an itemized statement. Please send it to me by mail.

Send it in writing within 30 days of the collector's first letter, when your rights are strongest, and keep a copy.

I'm paying for this myself. I'd like a Good Faith Estimate in writing before the appointment. Will any other provider bill me separately?

Ask when you schedule, or as soon as you know you will be paying yourself.

This medical debt is [paid / under $500 / less than a year old] and should not be on my report under the credit bureaus' medical debt policy. I'm asking you to remove it.

Send it in writing to the credit bureau showing the debt, with a copy of the paid receipt or the bill.

Was a claim for this date of service filed on time? If it was denied for timely filing, can you confirm in writing that the provider can't bill me for it?

Ask your insurer's member services first, then call the provider with the answer.

I'd like to set up a payment plan directly with the hospital. Is it interest-free, and can you send me the terms in writing?

If they offer a card or a loan instead, ask whether a plan with the hospital itself is available.

How do you charge: by the hour, a flat fee, or a share of what you save me? If it's a share, how do you work out the savings?

Ask it before you sign anything. A clear answer, in writing, is a good sign.

Can you tell me the exact reason code on this denial and what it means? And what documentation would you need to approve this?

Ask for the person's name and a reference number for the call before you hang up.

What documentation would you need to approve this?

Say it exactly like that. It turns a no into a to-do list.

I'd like to confirm that a prior authorization request was received for this service. Can you give me the authorization number and the dates it covers?

Call the number on the back of your insurance card, and write down the date, the name and the reference number.

I'm filing a formal internal appeal of this denial. Can you confirm the address or fax number, the deadline, and how I can check that it was received?

Say this on the phone before you send the letter, and write down the name of the person you spoke to.

I'm appealing a denial and I need a letter of medical necessity from the doctor. Here is the denial letter with the plan's reason. Can the letter answer that reason directly?

Offices get many of these requests; a clear ask and the denial letter in hand make it faster.

This is the plan's final internal decision, correct? I want to request an external review. Can you tell me exactly how to file it and the deadline?

Ask before the deadline on the letter; it is usually 4 months, but use the date printed.

Can you tell me the exact rejection reason from my plan? Is it a prior authorization, a quantity limit, a step-therapy rule, or is the drug not on the formulary?

While we sort this out, what else could help with this condition? Is there a lower-cost drug that works the same way, or a more natural approach, like changes in food, movement or a supplement? Which of those are safe with what I already take?

Ask the first question at the pharmacy counter, then repeat what you learned to the prescriber's office and ask them the second. Please don't stop or change a medication on your own.

I'm appealing this denial under the prudent layperson standard. My symptoms when I arrived were [describe them], and a reasonable person would have thought this was an emergency.

Fill in your actual symptoms; the standard is about what you knew then, not what the tests found later.

Please send me the clinical criteria you used to decide this was not medically necessary, and tell me who reviewed it. What documentation would you need to approve it?

Ask in writing too, through the plan's portal or by mail, so there is a record of the request.

I'd like to file a complaint about my health plan. Can you tell me whether your department regulates this plan and what documents to include?

Call the department's consumer help line first if you are not sure which agency covers your plan.

I'm requesting an external review of this final denial. Can you tell me whether this goes through the state or the federal process, and confirm the deadline?

Ask the plan first and, if the answer is vague, ask your state insurance department.

Could you give me your name and your role, please? I'm keeping notes for my mom so we can follow what's happening.

Say it warmly to every new person at the bedside. Most are glad someone is keeping track.

Can you walk me through the discharge plan, and tell me who has confirmed that insurance will cover it? I'd like that in writing before we leave.

Which facilities or home health agencies have you already sent my mother's information to? Which ones should I expect to call me?

Ask early in the stay. Hospitals often send a referral to several places at once to find an open bed, so calls can come before anyone has asked you. The list tells you who is calling, and the choice is still yours. A Friday discharge is hard to change over a weekend.

Is my mother admitted as an inpatient, or is she under observation? Could you note in the file that I asked, and let me know if it changes?

Ask every day. Status can change while they stay in the same bed.

We want her home, but we don't feel it's safe yet. During the day no one can be with her because we both work, and there are young children and a dog in the house who can't be left alone with her.

Could she have a therapy evaluation, and a check of her memory and thinking, before she leaves? What would need to be in place for her to go home safely?

Use your own details. Say it calmly to the case manager and the doctor, as early as you can, and ask them to note your concerns in her file.

Which care after the hospital is the doctor ordering, and has anyone confirmed it meets Medicare's coverage rules? Please send me that in writing.

Ask the case manager, and ask before the transfer is booked.

Based on what my mom can do today, which setting do you recommend, and why? What would she need at home for going home to be safe?

Ask the therapist, not only the doctor. Therapists see what the patient can actually do.

Could you tell me your name and your role on my father's care team? And who is the attending doctor today?

Ask the same question of each new face. It's normal, and it helps them too.

I'd like a second opinion before we decide. Can you send my records to another specialist, or tell me whom you would recommend?

Say it plainly. A good doctor will not take offense.

Can we have a palliative care consultation? And I'd like to understand honestly what to expect over the next few months.

Ask early. Palliative care works best when it starts before a crisis.

Does this hospital have an integrative medicine or whole health program? I'd like to know what it offers alongside my care, and how to get a referral.

Ask the nurse first. If they aren't sure, ask for the patient advocate or the patient relations office.

Can I talk with the dietitian? I'd like meals that fit my diet and also my tastes and my culture. Is it OK for my family to bring in food from home?

For a parent in a nursing home, add: "Please put her food preferences in her care plan."

Can you tell me the deductible and the out-of-pocket maximum for in-network care, and whether copays and prescriptions count toward the maximum?

Ask the plan, your employer's benefits office, or a SHIP counselor before you enroll, and ask for the answer in writing.

I received my Annual Notice of Change. Can you walk me through what changes for the drugs I take and the doctors I see, and confirm my premium and deductible for next year?

Call the number on your plan card. Ask them to note in your file that you called today.

Is my current doctor in this plan's network, and do I need a referral to see a specialist? What is covered if I get care outside the network?

Ask the plan, not the doctor's front desk, and ask them to confirm in writing.

I want to confirm that Dr. [name] at [practice] will be in network for the [plan name] plan next year. Can you note in my file that I called today and send me that in writing?

Say it to both the plan and the doctor's office. Keep the names and dates.

Is [drug name, strength] on your formulary for next year, which tier is it on, and does it need prior authorization or step therapy?

Besides this medication, are there natural options, like changes in food, movement or a supplement, that could help with this diagnosis? Would any of them be safe with what I already take, and could they ever mean needing less of a drug?

Ask the plan the first question, and your doctor or pharmacist the second. Please don't stop or change a medication on your own.

How are you paid for helping me, and does it change depending on which plan I choose? Which plans are you not able to show me?

Ask this at the start. An honest agent will answer without hesitation.

I enrolled in the wrong plan. Which enrollment period or Special Enrollment Period applies to me right now, and what is the last day I can make the change?

Say this to 1-800-MEDICARE or a SHIP counselor. Write down the date and the name of the person.

I lost my job coverage on [date]. Can you confirm my last day to elect COBRA, the exact monthly premium, and the date my first payment is due?

Say this to your former employer's HR office or the COBRA administrator named on the notice. Get it in writing.

I turn 65 in [month]. Can you confirm my Initial Enrollment Period dates, whether I will be enrolled in Part A automatically, and what I need to do to start Part B on time?

Say this to Social Security, which handles Medicare enrollment, or to a SHIP counselor.

Can you explain what I would pay for a hospital stay and for my regular medications under Original Medicare with a Part D plan, compared with this Advantage plan?

A SHIP counselor or 1-800-MEDICARE can answer this without selling you anything.

Mom, I noticed a few things this visit that I want to help with. Can we look at them together, and can I come along to your next doctor's appointment?

Say it in private, when you are both calm, not at the dinner table with everyone there.

Dad, if you ever couldn't speak for yourself, who would you want making the decisions? Let's write that down so the hospital listens to the person you choose.

Frame it as your parent staying in charge, not as you taking over.

I'm calling about my father. He signed a release for me, and it should be in his file. Can you walk me through what the results mean and what happens next?

If the office says they can't talk to you, ask them to check the file for the release, then ask what form they need.

I'm requesting a copy of my mother's records under HIPAA. Her signed authorization is attached. Please tell me the fee and the date I can expect them.

Put it in writing (portal message, email or letter) so the 30 days start on a date you can prove.

Can you note in his file that I called today, and can you give me a reference number for this call?

Say it at the end of every call with an insurer or a billing office. Write the number in your log before you hang up.

Before we sign anything, can you tell me in writing what the daily rate includes, whether you accept Medicaid, and what happens if my parent's money runs out?

Ask before admission. If the facility accepts Medicaid, your parent may be able to stay when private funds run out.

What would have to change in my mother's condition for you to say she can no longer stay here? And who makes that call?

Ask this at every place you visit. The answer tells you how long the option will really last.

Doctor, I'd like to understand where we are. Is it time to talk about hospice or palliative care, and what would each one change for my mother?

Ask at a scheduled visit, with your parent's permission, and bring someone to take notes.

Can we schedule a care conference this week? I'd like the doctor or nurse practitioner, the therapist and the social worker there, and I'll send my questions ahead of time.

In a nursing facility, your parent and their representative have a right to take part in care planning; in a hospital, ask the case manager.

Mom, I'm far away, and I want to be able to help fast if something happens. Can we set up a few things this week so I can talk to your doctor and your bank if I ever need to?

Bring the forms with you. The visit is short, and ordering them later loses the momentum.

I signed as my mother's representative, to pay from her income and savings. I did not agree to pay from my own money. Please send me the itemized bill and the page of the contract you are relying on.

Send it in writing and keep a copy. A phone call leaves no record.

Mom, I'm not asking you to give anything up. Would you let a nurse come once, just so we know what help is there if you ever want it?

Ask for one visit, not a decision. A first hospice or palliative care visit is for information, and hospice can be stopped at any time.

Doctor, I'm worried about Dad living alone. Here is what I've seen. Could you do a full cognitive assessment and tell us what support he needs to stay safe at home?

Ask your parent if you can come to the visit. Medicare says a patient can bring someone along to listen and answer questions.

Have you helped with a situation like ours? How do you charge, does anyone else pay you, like a hospital, insurer or care facility, and what will you need from us to get started?

Ask every advocate the same questions, so you can compare the answers side by side.

Is acupuncture covered under my plan, and for which conditions? How many visits a year, and do I need a referral or approval first?

Write down the name of the person you spoke to, the date and a reference number.

My doctor recommends this to treat a diagnosed condition. Can you write that in a short letter I can send to my FSA, with my diagnosis and how long I should take it?

Say it to your doctor. Many administrators call this a letter of medical necessity.

Before we add a medication, what else could help? Could we try something without medication first, or use it alongside?

Say it to the doctor or nurse. If you are the family member, add: "This matters to her. Can we talk about it today?"

Does the hospital offer massage or acupuncture for patients? I'd like to try it for my pain, alongside my care. Who do I ask to set it up?

Say it to the nurse first. For a parent, say "for my mother's pain" and ask the same way.

Are you licensed in this state, and are you board certified? Have you helped people with [my back pain] before, and how many visits do you usually suggest before we see how it's going?

Ask each acupuncturist the same questions. Then choose the one you feel comfortable with.