A narrow script for a prior authorization status call
Editorial disclosure: Prepared by the Patient Bill Community Team for general education. This is not a real patient story and is not individualized medical or legal advice.
Call rehearsal: replace “Was it approved?”
That yes-or-no question can hide a pending request, a partial approval, or a request that never reached the correct department. Rehearse the call in four short rounds.
Opening: “I am checking the current administrative status of a prior authorization request. Please describe it as received, pending, awaiting information, partially approved, approved, or denied.”
If records are missing: Ask for the exact document type, the date the plan last checked, who may send it, and the secure destination. Then contact the ordering office and request transmission confirmation. “Clinical notes” is too broad; the missing item might be a therapy history, imaging report, or signed order.
If approval is limited: Read back the service, quantity, location, effective period, and any related item that is not included. Six visits approved is different from an unrestricted course. Approval also does not establish the final bill.
If denied: Request the written criterion, decision notice, review deadline, submission channel, and any standard or expedited pathway described by the plan. Ask whether a clinician discussion is available and whether it changes any appeal deadline; do not assume those processes are interchangeable.
Close with: “What should happen next, who is expected to act, and where will the written status appear?” Record the department, call date, and promised follow-up privately. A portal message can help confirm what was said.
The treating clinician—not a call script—addresses urgency, alternatives, and whether delay is medically acceptable. Contact that team promptly when timing matters. Do not post authorization pages or health records in the community. HealthCare.gov’s appeal information outlines general review rights, but the plan notice controls the case-specific route.