How to talk to Health Insurance - with a script!

Talking to your health insurance carrier can feel overwhelming, but with a little preparation and patience, you can make the process much smoother. Whether you're calling to check benefits, resolve a claim, or get clarification on a policy, here are some practical tips to help you navigate the conversation confidently.

While tempting to tell them to f*ck off in the most brutal of ways, this is not the recommended approach. Instead, we recommend the following:

• Be prepared. Gather all the info you need ahead of time, along with a paper and pen for notes.

• Call during off-peak hours (mid-morning or mid-afternoon).

• Stay calm and polite.

• Take notes and ask for clarification.

• Confirm next steps.
  

  Talking to your health insurance carrier doesn’t have to be daunting. With preparation, patience, and a clear understanding of your goals, you can advocate for yourself effectively and get the information or resolution you need. Pair these tips with the provided call script for even more confidence in your next conversation!
  

  Script:

  
  1. Introduce Yourself and Your Purpose

  “Hello, my name is [Your Name], and I’m calling to get clarification on why my claims for [Service Type, e.g., therapy sessions] are not being paid. Can you assist me with this?”

  2. Provide Necessary Identifying Information

  “I’d like to provide my information so you can locate my account:

  • Full Name: [Your Full Name]

  • Date of Birth: [Your Date of Birth]

  • Member ID: [Your Member ID from your insurance card]

  • Provider’s Name: [Name of Provider]

  • Dates of Service: [Relevant Dates of Service]

  Could you confirm that you have all the information you need to pull up my file?”

  3. State the Issue Clearly and Ask for Specifics

  “I noticed that my claims for [Service Type] on [Dates] have not been paid. Could you please explain the reason for this?”
  

  4. Follow-Up Questions for Clarity

  If the response is unclear or inadequate, ask for more specifics:

  • “Can you provide the exact reason for the denial or delay?”

  • “Are there any issues with coverage or documentation?”

  • “Is there anything additional my provider or I need to submit?”

  • “Can you provide me with a reference or claim number for these services?”

  
  5. Hold the Insurance Company Accountable

  If the issue lies with the insurance company:

  • “According to my policy, these services should be covered. Can you explain why they are not?”

  • “Is there a supervisor I can speak with for further clarification?”

  • “Can you walk me through the appeal or resolution process?”

  6. If the Issue Is on the Provider’s End

  If they mention missing information or errors from the provider:

  • “Could you tell me exactly what is missing or incorrect?”
    

  • “Would it be possible to provide me with documentation or communication I can share with my provider?”

  7. Request Documentation or Confirmation

  “Can you send me a detailed explanation of the issue, including any denial codes or claim details? I’d like to have this in writing for my records. How long will it take to receive this?”

  8. Set Expectations for Follow-Up

  “Based on this conversation, what is the next step to get this resolved? When should I expect this to be taken care of, and who should I contact if it isn’t?”

  9. Close the Call Professionally

  “Thank you for helping me today. I’ll follow up as needed based on the timeline you’ve provided. May I have your name and reference number for this call in case I need to call back?”