该怎么说：所有话术汇总

我想申请一份附有账单代码的明细账单。我不是拒绝付款，我只是想要一份我能核实的账单。 [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.]

平静地对账单上列出的账单部门说这句话，并请他们在您的档案里记录您今天来过电话。

我想申请我 [日期] 就诊的明细账单，附上账单代码。能否在我的档案里注明我今天来过电话？ [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?]

如果他们问为什么，您可以说：我想把它和我的福利说明对照一下，就是保险公司寄给我的那份说明。[I want to check it against my Explanation of Benefits, the statement my insurer sent me.]

能否告诉我，今年我的免赔额已经付满了多少，以及哪一天重新计算？ [Can you tell me how much of my deductible I've met this year, and on what date it resets?]

打保险公司的会员服务电话，就是您保险卡背面的那个号码。

能否告诉我这张账单来自哪家医疗机构、他们是否在我的网络内，以及它对应保险公司那边的哪个理赔编号？ [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?]

问每张账单上列出的账单部门；即使是同一次就诊，它们也常常是不同的部门。

我的 EOB 显示我应付的金额和贵方的账单不一样。能否告诉我差额的确切原因，并以书面形式给我寄一份更正后的账单？ [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?]

把两份文件都放在面前，准备好理赔编号和服务日期。

我想把这笔账单处理好。请问一次性付清有没有折扣，或者有没有我可以申请的财务援助项目？我们商定的任何内容，请以书面形式发给我。 [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.]

问账单部门或患者财务服务部（patient financial services），而不是催收机构。

我想根据贵院的政策申请财务援助。能否把申请表寄给我，并在审核期间暂停这个账户的催缴？ [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?]

即使您有保险，甚至已经开始付款，也可以申请。

我认为这是一张受《无意外账单法》（No Surprises Act）保护的意外账单。请按网络内费率向我的保险公司收费，并以书面形式告知我。 [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.]

对医生诊所的账单部门这样说，并在同一天告诉您的保险公司。

我对这笔债务提出异议，并要求书面核实，包括原始医疗机构、服务日期和一份明细账单。请通过邮寄方式发给我。 [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.]

在收到催收方第一封信后的 30 天内以书面形式寄出，这段时间您的权利最有保障，并保留一份副本。

这次费用由我自己支付。我希望在就诊之前拿到一份书面的善意估价（Good Faith Estimate）。还会有其他医疗机构单独向我收费吗？ [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?]

在预约时就问，或者一知道要自己付费就问。

这笔医疗债务【已付清 / 低于 $500 / 不满一年】，根据各征信机构的医疗债务政策，不应出现在我的信用报告上。我要求将其删除。 [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.]

以书面形式寄给显示这笔债务的征信机构，并附上付款收据或账单的副本。

这个服务日期的理赔有没有按时提交？如果它因逾期提交遭拒赔，您能否以书面形式确认医疗机构不能为此向我收费？ [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?]

先问保险公司的会员服务部（member services），再拿着答复打电话给医疗机构。

我想直接和医院签一份分期付款计划。这是免息的吗？能否把条款以书面形式发给我？ [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?]

如果他们改为推荐信用卡或贷款，问一问能不能直接和医院签分期计划。

您怎么收费：按小时、固定费用，还是按为我省下的钱抽成？如果是抽成，省下的钱怎么计算？ [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?]

在签任何文件之前就问。能给出清楚的书面答复，是个好兆头。

能否告诉我这次拒赔的确切原因代码，以及它是什么意思？另外，贵方需要哪些文件才能批准这项申请？[Can you tell me the exact reason code on this denial and what it means? And what documentation would you need to approve this?]

挂电话之前，记下对方的姓名和这次通话的参考编号。

贵方需要哪些文件才能批准这项申请？[What documentation would you need to approve this?]

就照这句话原样说。它能把一个“不行”变成一张待办清单。

我想确认贵方已经收到这项服务的事先授权申请。能否告诉我授权编号，以及授权涵盖的日期？[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?]

拨打您保险卡背面的电话，并记下日期、对方姓名和参考编号。

我要就这次拒赔提出正式的内部申诉。能否确认地址或传真号码、期限，以及我如何核实贵方已经收到？[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?]

寄信之前先在电话里这样说，并记下接电话的人的姓名。

我正在对一次拒赔提出申诉，需要医生写一封医疗必要性证明信。这是拒赔信，上面有计划给出的理由。这封证明信能否直接回应这个理由？[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?]

医生诊所会收到很多这样的请求；提出清楚的要求并带上拒赔信，事情会办得更快。

这是计划最终的内部决定，对吗？我想申请外部复审。能否确切告诉我如何提交，以及期限是哪天？[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?]

在信上的期限之前问；期限通常是 4 个月，但请以信上印的日期为准。

能否告诉我计划给出的确切拒绝原因？是需要事先授权、有数量限制、有阶梯治疗规定，还是这种药不在药物目录上？[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?]

在我们处理这件事期间，还有什么可以帮助治疗这个病？有没有作用相同但更便宜的药，或者更自然的办法，比如饮食、运动方面的调整或某种补充剂？其中哪些与我现在服用的药一起用是安全的？[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?]

第一个问题在药房柜台问，然后把了解到的情况告诉开药医生的诊所，再问他们第二个问题。请不要自行停药或换药。

我根据“谨慎的普通人标准”（prudent layperson standard）对这次拒赔提出申诉。我到达时的症状是 [描述症状]，一个普通明理的人会认为这是紧急情况。[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.]

填上您实际的症状；这个标准看的是您当时知道什么，而不是检查后来发现了什么。

请把贵方用来判定这项医疗没有医疗必要性的临床标准寄给我，并告诉我是谁审核的。贵方需要哪些文件才能批准？[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?]

同时也通过计划的网上平台或邮寄，以书面形式提出，这样这次请求就有了记录。

我想就我的健康保险计划提出投诉。能否告诉我，贵部门是否监管这个计划，以及我需要附上哪些文件？[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?]

如果您不确定哪个机构负责您的计划，先拨打该部门的消费者求助热线。

我要对这次最终拒赔申请外部复审。能否告诉我，这是走州里的程序还是联邦的程序，并确认期限？[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?]

先问计划；如果回答含糊，就问您所在州的保险监管部门。

可以告诉我您的姓名和职务吗？我在替我妈妈做记录，好让我们随时了解情况。 [Could you give me your name and your role, please? I'm keeping notes for my mom so we can follow what's happening.]

每当有新的医护人员来到床边，都友善地这样说一句。大多数人都乐意看到有人在做记录。

能否跟我一步步讲讲出院计划，并告诉我是谁确认了保险会承保？我希望在我们离开之前拿到书面材料。 [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.]

请问医院已经把我母亲的资料发给了哪些机构或居家医疗服务机构？我应该等哪些机构给我打电话？ [Which facilities or home health agencies have you already sent my mother's information to? Which ones should I expect to call me?]

在住院初期就问。医院常常同时向好几家机构发送转介（referral），以便找到空床位，所以在任何人征求您意见之前，就可能有电话打来。这份名单让您知道是谁在打电话，而选择权仍然在您手里。周五出院的安排，很难在周末期间更改。

我母亲是作为住院病人收治的，还是处于观察状态？能否在档案里注明我问过这个问题，并在状态改变时告诉我？[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?]

每天都问。即使一直躺在同一张病床上，状态也可能改变。

我们希望她回家，但我们觉得现在还不安全。白天我们两个都要上班，没有人能陪她，而且家里有年幼的孩子和一条狗，不能让他们和她单独待在一起。 [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.]

她离开之前，能否做一次治疗评估，并检查一下她的记忆和思维？需要具备哪些条件，她才能安全回家？ [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?]

换成您自己的具体情况。尽早、平静地对个案管理员和医生说，并请他们把您的顾虑记入她的档案。

医生开的是哪种出院后的医疗服务？有没有人确认过它符合 Medicare 的承保规则？请把这些以书面形式发给我。 [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.]

问个案管理员，而且要在转院安排确定之前问。

根据我妈妈现在的身体状况，您建议哪种安置方式？为什么？如果回家，她需要哪些条件才能安全？ [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?]

要问治疗师，而不只是问医生。治疗师看得到患者实际能做什么。

能否告诉我您的姓名，以及您在我父亲的医疗团队里的职务？今天的主治医生是谁？ [Could you tell me your name and your role on my father's care team? And who is the attending doctor today?]

对每一张新面孔都问同样的问题。这很正常，对他们也有帮助。

在我们做决定之前，我想听听第二意见。能否把我的病历寄给另一位专科医生，或者告诉我您会推荐谁？[I'd like a second opinion before we decide. Can you send my records to another specialist, or tell me whom you would recommend?]

直接说出来。好医生不会因此不高兴。

我们可以安排一次缓和医疗会诊吗？另外，我想坦诚地了解接下来几个月可能会发生什么。[Can we have a palliative care consultation? And I'd like to understand honestly what to expect over the next few months.]

早点问。缓和医疗在危机出现之前开始，效果最好。

这家医院有整合医学或全人健康项目吗？我想了解它能在我现有治疗之外提供什么，以及怎样获得转诊。 [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.]

先问护士。如果护士不确定，就请找患者权益代表或患者关系办公室（patient relations office）。

我可以和营养师谈谈吗？我希望饭菜既符合我的饮食要求，也合我的口味和文化。我的家人可以从家里带饭菜来吗？ [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?]

如果父母住在养老院，再加一句：“请把她的饮食偏好写进她的护理计划。” [Please put her food preferences in her care plan.]

能否告诉我网络内医疗的免赔额和自付费用上限，以及定额自付费（copay）和处方药是否计入上限？[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?]

投保之前，向保险计划、雇主的福利部门或 SHIP（州健康保险援助计划）顾问询问，并要求书面答复。

我收到了年度变更通知。能否帮我逐项说明，我服用的药和我看的医生会有哪些变化，并确认我明年的保费和免赔额？[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?]

拨打您的计划会员卡上的电话。请他们在您的档案里注明您今天来过电话。

我现在的医生在这个计划的网络内吗？看专科医生需要转诊吗？如果我在网络外就医，哪些会被承保？[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?]

问保险计划，而不是医生的前台，并请他们以书面形式确认。

我想确认 [诊所] 的 [姓名] 医生明年会在 [计划名称] 计划的网络内。能否在我的档案里注明我今天来过电话，并把确认以书面形式寄给我？[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?]

对保险计划和医生诊所都这样说。保留姓名和日期。

[药名、剂量强度] 在贵计划明年的药物目录上吗？它在哪个等级？需要事先授权或阶梯治疗吗？[Is [drug name, strength] on your formulary for next year, which tier is it on, and does it need prior authorization or step therapy?]

除了这种药，有没有一些自然的方法，比如饮食、运动方面的调整或某种补充剂，可能对这个诊断有帮助？它们与我现在服用的药一起用安全吗？有没有可能让我需要的药量减少？[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?]

第一个问题问保险计划，第二个问题问您的医生或药剂师。请不要自行停药或换药。

您帮我是怎么拿报酬的？报酬会不会因为我选择的计划不同而不同？有哪些计划是您不能给我看的？[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?]

一开始就问。诚实的代理人会毫不犹豫地回答。

我选错了计划。我现在适用哪个投保期或特殊投保期？我最晚哪一天可以更改？[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?]

对 1-800-MEDICARE 或 SHIP 顾问这样说。记下日期和对方的姓名。

我的雇主保险在 [日期] 终止了。请问我最晚哪天要选择 COBRA？每月保费具体是多少？第一笔保费哪天之前要交？[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?]

对您前雇主的人力资源（HR）部门，或通知上列出的 COBRA 管理方这样说。要拿到书面答复。

我在 [月份] 年满 65 岁。能否确认我的初始投保期日期、我是否会被自动登记参加 Part A，以及我需要做什么才能按时开始 Part B？[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?]

对负责 Medicare 投保的 Social Security（社会安全局），或对 SHIP（州健康保险援助计划）顾问这样说。

能否解释一下：如果选原始 Medicare 加 Part D 计划，和选这个 Advantage 计划相比，我住一次院、买平时用的药，分别要付多少钱？[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?]

SHIP 顾问或 1-800-MEDICARE 可以回答这个问题，而且不会向您推销任何东西。

妈，这次回来我注意到几件事，想帮您一起处理。我们能一起看看吗？下次您去看医生，我能陪您去吗？

私下说，在你们两个人都平静的时候说，不要在全家人都在场的饭桌上说。

爸，要是哪天您没法替自己说话了，您希望由谁来替您做决定？我们把这个写下来，这样医院就会听您选定的那个人的意见。

要让父母感到这是他们自己继续做主，而不是您要接管。

我是为我父亲打来的。他给我签了一份授权书，应该在他的档案里。能否给我讲一下这些结果是什么意思，接下来会怎样？[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?]

如果诊所说不能和您谈，请他们在档案里查找那份授权书，然后问他们需要什么表格。

我根据 HIPAA 申请我母亲病历的副本。她签署的授权书已附上。请告诉我费用，以及我预计哪一天能收到。[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.]

以书面形式提出（门户网站消息、电子邮件或信件），这样 30 天就从一个您能证明的日期开始计算。

能否在他的档案里注明我今天来过电话？能否给我这通电话的参考编号？[Can you note in his file that I called today, and can you give me a reference number for this call?]

每次和保险公司或账单部门通话结束时都这样说。挂电话之前，把编号写进您的通话记录。

在我们签任何文件之前，能否以书面形式告诉我：每日费用包含哪些项目、贵机构是否接受 Medicaid，以及如果我父母的钱用完了会怎样？[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?]

入住之前就问。如果机构接受 Medicaid，您的父母在私人资金用完后也许可以继续住下去。

我母亲的身体状况要出现什么样的变化，你们才会说她不能再住在这里？这个决定由谁来做？[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?]

在您参观的每个地方都问这个问题。对方的回答会告诉您，这个选择真正能维持多久。

医生，我想了解一下目前的情况。现在是不是该谈谈安宁疗护或缓和医疗了？这两种照护各自会给我母亲带来什么改变？[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?]

在预约好的就诊时间问，事先征得您父母的同意，并带一个人帮忙记笔记。

这周我们能安排一次照护会议吗？我希望医生或执业护士、治疗师和社工都能参加，我会提前把问题发过去。[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.]

在护理机构里，您的父母及其代表人有权参与制定照护计划；在医院里，请询问个案管理员。

妈，我离得远，万一有什么事，我希望能马上帮上忙。这周我们能不能把几件事办好，这样如果哪天需要，我就能和您的医生和银行沟通？

把表格随身带去。探望的时间很短，等之后再去要表格，事情就容易搁下了。

我是以母亲代表人的身份签字的，用她的收入和积蓄付款。我没有同意用我自己的钱付款。请把明细账单，以及你们所依据的那一页合同寄给我。[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.]

请以书面形式寄出并保留副本。打电话不会留下记录。

妈，我不是要您放弃什么。能不能让护士来一次，就一次，好让我们知道万一您哪天需要，有哪些帮助？

只请他们同意一次探访，而不是要他们做决定。第一次安宁疗护或缓和医疗探访只是为了了解信息，而且安宁疗护随时可以停止。

医生，我担心我父亲一个人住。这是我观察到的情况。您能不能给他做一次全面的认知评估，并告诉我们他需要哪些支持，才能安全地住在家里？[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?]

问问您的父母能不能陪他们去看医生。Medicare 说明，患者可以带一个人同去，帮忙听和回答问题。

您帮过和我们情况类似的家庭吗？您怎么收费？有没有其他人付钱给您，比如医院、保险公司或护理机构？开始之前，您需要我们提供什么？ [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?]

对每位顾问都问同样的问题，这样就能把答案放在一起比较。

我的计划承保针灸吗？针对哪些病症？每年能报几次？需要先转诊或先获批准吗？ [Is acupuncture covered under my plan, and for which conditions? How many visits a year, and do I need a referral or approval first?]

记下接电话的人的名字、日期和参考编号。

您建议我用这个来治疗已确诊的病症。能不能帮我写一封简短的信，让我交给 FSA，写上我的诊断以及需要用多久？ [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?]

对您的医生这样说。很多管理机构把这叫做医疗必要性证明信（letter of medical necessity）。

在加药之前，还有什么能帮上忙？我们能不能先试试不用药的办法，或者和药物一起用？ [Before we add a medication, what else could help? Could we try something without medication first, or use it alongside?]

对医生或护士说。如果您是家属，再加一句：“这对她很重要。我们今天能谈谈吗？” [This matters to her. Can we talk about it today?]

医院有没有为患者提供按摩或针灸？我想在现有治疗之外，试试用它来缓解疼痛。我该找谁安排？ [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?]

先对护士说。如果是为父母问，就说“为了我母亲的疼痛” [for my mother's pain]，问法一样。

您在本州有执照吗？有没有通过全国委员会认证？您以前帮过有【我的腰背痛】这类问题的人吗？通常建议先做几次，再看看效果如何？ [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?]

对每位针灸师都问同样的问题，然后选一位让您感到放心的。