Phone call script generator
Fill in a few details and get a calm, ready-to-read script for confirming contracted rates, modifiers, and in-network status — plus the exact questions to ask.
Phone call script generator
Your call script
Hi, my name is [Your name]. My member ID is [Member ID]. I'm calling to confirm coverage and contracted pricing for code [CPT/HCPCS code], scheduled or performed on [Date of service] at [Provider or facility name]. Could you please confirm: 1. Is [Provider or facility name] in-network for my plan on that date? 2. Is code [CPT/HCPCS code] a covered service under my plan? 3. What is the contracted/allowed amount for [CPT/HCPCS code] at this provider? 4. Are any modifiers expected (for example -25, -26, -59, -TC) and how do they affect what I owe? 5. Is prior authorization required? If yes, is it already on file? 6. After my deductible and coinsurance, what is my estimated out-of-pocket? 7. Will any portion be billed by a separate provider (anesthesia, radiology, pathology, lab)? Are those providers in-network? Before we hang up, can I get: - A reference number for this call - Your name and ID - Confirmation in writing or via the member portal Thank you.
Key questions for your insurer
- Is this provider in-network on my date of service?
- What is the contracted (allowed) amount for this code?
- What modifiers are expected and how do they change my cost-share?
- Is prior authorization required — and is it already approved?
- What's my estimated out-of-pocket after deductible and coinsurance?
- Are any ancillary providers (anesthesia, radiology, pathology, lab) out-of-network?
- Can I get this confirmation in writing or in the member portal?
Always log: the date and time of the call, the rep's name and ID, and a reference number. Quote these back if a bill later contradicts what you were told.
After the call — next steps with deadlines
- Priority
Save the rep's name, ID, and the reference number in your records — you'll need it if a bill contradicts what you were told.
TodayDue today Screenshot the insurer's online provider directory for your plan + date of service, or request written confirmation via the member portal.
By Fri, Sep 4 (+2d)- Priority
Call back (or check the portal) to confirm the auth number, approved CPT code(s), date range, and approved facility. Get the auth number in writing.
By Sat, Sep 5 (+3d) Federal No Surprises Act: providers must give a written estimate on request. Ask for it at least 3 business days before service.
By Mon, Sep 7 (+5d)Anesthesia, radiology, pathology, and lab are often billed separately. Get each one's network status in writing for your specific date and facility.
By Mon, Sep 7 (+5d)If the provider's estimate is more than $400 above the Good Faith Estimate, you may dispute it through the federal Patient-Provider Dispute Resolution process.
By Wed, Sep 9 (+7d)If you don't have written confirmation of network status, prior auth, and the cost estimate, call back before the date of service.
By Sat, Sep 12 (+10d)
Deadlines are anchored to the day you first opened this checklist. Reset to re-anchor to today.
Log a call
Saved calls
No calls logged yet. Save your first call above.