Patient Track: Being good at makeup, didn’t mean I was well.
Disclaimers.
Professional Standards and Scope:
Credentials and expertise: Dr. Stephanie Michelle Nixon is a PhD-level Speech-Language Pathologist and consultant.
Educational purpose: The content in this series is shared for informational, educational, and advocacy purposes only.
No clinical relationship: Engagement with this content does not constitute medical advice, a clinical diagnosis, or the establishment of a patient-provider relationship.
Medical consultation: Always seek the advice of your physician or other qualified health providers with questions regarding a medical condition.
Personal Narrative & Data Integrity:
Designated Record Set: This series represents a personal, professional audit of my own legally obtained medical history and “Designated Record Set”.
Factual Basis: All clinical data points—including the 169.4-minute gastric emptying result —are pulled directly from my documented clinical records.
Advocacy Intent: My goal is to highlight systemic disparities in medical documentation and foster better clinical communication.
Non-Defamation: This audit is a critique of the content and quality of documentation and the patterns of clinical bias, rather than an attack on specific individuals or institutions.
A Note on Neurodivergent Baseline:
Contextual Accuracy: Observations regarding communication style, energy, or behavior (often labeled “manic” or “pressured” in my records) must be viewed through the lens of my documented, lifelong ADHD diagnosis.
A ‘u’ was added (AuDHD) as a late diagnosis a few years ago providing a key to understanding why so many providers saw ‘manic’ behavior where there was actually just a neurodivergent person managing a health emergency. We have to stop labeling what we don’t understand.
Which version of you is in your medical record? On the right are the labels found in my permanent charts—words like “typical,” “rushed,” “not sick appearing”, “well groomed”. On the left is the objective data my body was reporting at that exact same time.
Words have weight. After auditing my own medical charts across different institutions, it became obvious just how much weight those words carry—and how they can shadow a patient for decades. And let me say, words can hurt.
During an initial appointment years ago, a provider looked at me and said, “You look well.” My response came quickly: “I’m good at makeup.”
How many of us get up, put on our “mask” (a smile, our makeup, shallow breaths to avoid a cough), and go about our day? I know I did. I watched TikToks to improve my makeup skills while I was getting sicker. I didn’t want the world to see me looking as bad as I felt.
But do we really need to look as bad as we feel for a provider to believe the data? I once showed a provider a photo of myself before I put on my makeup that morning, just so she could see the reality of my physical state. Her response? “Why are you showing me this?”
Looking back, I realize that if a provider needs you to look “sick enough” to believe your symptoms, they aren’t the right provider for you.
Receipts
The Science: A specialist was “not convinced” I had a condition, despite a nuclear study providing a 169.4 minute gastric half-time – nearly double the normal limit.
The “Well-Appearing” Paradox: My chart once documented me as “well-appearing” and in “no acute distress” while my oxygen saturation was recorded at 65% at room air. (Note. The 65% was likely associated with PVCs.)
The “Performance” Label: My cough was described as something I “demonstrated” when I was actually navigating multiple bacterial respiratory infections (including … MAC and Staph).
The Missing “u”: My speech was labeled as “pressured,” a psychiatric term that completely ignored my AuDHD baseline (ADHD 1979 / Autism 2024; iykyk).
Audit Your Medical History
Have you ever found a statement in your records that felt more like a character critique than a clinical note?
What is one “label” a provider gave you that was the complete opposite of your reality?
How did it change the way you presented yourself at your next visit?
Provider Track: Would you want these words in your permanent record?
Disclaimers.
Professional Standards and Scope:
Credentials and expertise: Dr. Stephanie Michelle Nixon is a PhD-level Speech-Language Pathologist and consultant.
Educational purpose: The content in this series is shared for informational, educational, and advocacy purposes only.
No clinical relationship: Engagement with this content does not constitute medical advice, a clinical diagnosis, or the establishment of a patient-provider relationship.
Medical consultation: Always seek the advice of your physician or other qualified health providers with questions regarding a medical condition.
Personal Narrative & Data Integrity:
Designated Record Set: This series represents a personal, professional audit of my own legally obtained medical history and “Designated Record Set”.
Factual Basis: All clinical data points—including the 169.4-minute gastric emptying result —are pulled directly from my documented clinical records.
Advocacy Intent: My goal is to highlight systemic disparities in medical documentation and foster better clinical communication.
Non-Defamation: This audit is a critique of the content and quality of documentation and the patterns of clinical bias, rather than an attack on specific individuals or institutions.
A Note on Neurodivergent Baseline:
Contextual Accuracy: Observations regarding communication style, energy, or behavior (often labeled “manic” or “pressured” in my records) must be viewed through the lens of my documented, lifelong ADHD diagnosis.
A ‘u’ was added (AuDHD) as a late diagnosis a few years ago providing a key to understanding why so many providers saw ‘manic’ behavior where there was actually just a neurodivergent person managing a health emergency. We have to stop labeling what we don’t understand.
medical gaslighting and the importance of accurate, data-driven medical records for neurodivergent (AuDHD) patients." class="wp-image-967" srcset="https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-1024x1003.png 1024w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-300x294.png 300w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-768x752.png 768w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-1536x1505.png 1536w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-2048x2006.png 2048w" sizes="(max-width: 1024px) 100vw, 1024px" />
Clinical documentation is a record of pathology, not a character assessment. Yet, after auditing my own medical records, I found decades of “subjective” notes that had nothing to do with my physiological state and everything to do with a provider’s snap judgement and dismissal of my lived reality.
It doesn’t matter if a provider feels these words “justified” in the moment. Once they are in the patient’s chart, they become a permanent filter for every provider who follows.
The words on the black and white side minimize and dismiss both objective findings and my symptoms.
In the image above, a provider documented that my degree of disability ‘surpassed objective findings.’ In doing so, they failed to recognize my functional reality: I was a Speech-Language Pathologist unable to see my patients for 3 weeks after losing my voice to an ulceration on my vocal fold. When documentation focuses on ‘surpassing findings’ but ignores a total loss of vocational function, the clinical record is incomplete. We must document the patient’s life, not just the provider’s impression.
The Scope-of-Practice Gap:
I found repeated psychiatric judgments—labels like ‘pressured speech’ and ‘somatization’—written by specialists who were not psychiatrists or behavioral neurologists. Labeling a communication style as ‘pressured speech’ without establishing a neuro-informed baseline (AuDHD) isn’t just a misinterpretation—it is a specialist overstepping their scope to pathologize a natural speech rate instead of investigating physical health.
What they called “pressured”:
A Neurodivergent Baseline: If anyone had paused to ask, I would have laughed and told them that I had the words “SLOW DOWN!” in bold on every note for every presentation during my post-graduate education.
Physiological Distress: Rapid speech and “short rushes” are frequently associated with shortness of breath. Documentation that reaches for a psychiatric label while a patient is in respiratory distress is a failure of clinical reasoning.
Fluency Dynamics: As an SLP, I recognize these patterns as potential symptoms of cluttering among other speech and language disorders.
None of these clinical presentations require a mental health diagnosis. When we reach for mental health labels to describe a fast speech rate, we ignore the very real physical or fluency-based realities of the patient standing in front of us.
The “Incidental” Dismissal
I once had a specialist (not a gynecologist or GI) dismiss my appendectomy as “incidental” to my laparoscopy for Stage IV extra-pelvic endometriosis. When a pathology report confirms ‘Appendix – Endometriosis,’ that appendectomy is a diagnostic data point, not an ‘incidental’ event. Labeling it as such signals to every future provider that the patient’s surgical history—and their reported pain—is irrelevant.
The Receipts:
The Science: A 169.4-minute gastric half-time (normal is <90) was dismissed by a specialist who was “not convinced.”
The Paradox: A 65% O2 saturation reading was recorded alongside a note that I was “well-appearing”. (Note. The 65% O2 reading was likely associated with PVCs based on the other data in the visit.)
The Shorthand: A systemic crisis involving a 20-lb weight gain and pitting edema was labeled “long story typical for Stephanie”.
The Challenge:
The Mirror Test: If you were the patient, would you want a crisis described as “typical” for you?
Stay in Scope: If you aren’t a psychiatrist, why are you reaching for psychiatric labels to describe a patient’s communication? (Also, check with the patient. Had that provider asked me, I would’ve laughed and told her that my rate of speech has always been fast…in fact, I must actively think about it to speak more slowly.)
Watch for Bias: Literally watch for it. If you see a dismissive note from a colleague, don’t carry it forward. Check the data, ask the patient, and document the objective truth.
Let’s hold the record to a higher standard. How can we ensure our “Subjective” notes don’t do lasting harm?
In a world of sponsored “health tech” content, here is the truth:
I am a paying subscriber of Perplexity Pro ($20/mo) and a paying subscriber of the Guava Health Family Plan.
While I serve on the Guava Health Patient Advisory Panel, I do so pro bono (unpaid).
This review is not a promotion; it is a clinical audit. I’ve spent my own money on these tools because I am a “spoonie” patient, provider, and researcher searching for a way to make a complex life more manageable. (But for the record, I do accept cookies.)
The Dangerous Illusion of “All Your Data”
The biggest risk of Perplexity Health (Beta) is the illusion of completeness. Its marketing promises a seamless “Health Hub,” but my testing revealed a dangerous “blind spot.” Despite being connected to my EMRs, Perplexity ignored my most recent labs and defaulted to a T4 Free result from 2021 as my “current” status.
The Safety Warning: If a patient trusts Perplexity’s dashboard, they might miss key data and believe they are clinically stable when the AI is simply “ignoring” the last five years of their data because it didn’t index in a way the AI could add to your biomarkers.
The Guava Advantage: Guava understands that medical data is messy. Even when a provider doesn’t have a direct API integration, Guava allows you to upload the report. The platform doesn’t just “store” the PDF; it indexes and pulls that data into your biomarkers, ensuring your trends are accurate and complete (or as complete as the data it obtains via APIs and your uploads).
Data Latency Proof. Perplexity remained stuck in 2021 despite current data being physically present in the system.
The “Spoonie Tax”: Friction as a Barrier
Chronic illness management is often a full-time job. We use technology to save “spoons,” not spend them. Perplexity, however, added to that fatigue through technical friction:
The Quantity and Size File Wall
I could only upload 200 documents. As a person with chronic illness who has been on this earth more than say 40 years, that didn’t begin to cover even half of my documents. You might tell me, ‘Just upload the most important ones’ or ‘Import them from the provider’, well, I tried that.
The connection to my primary care provider’s office linked to her old facility vs. the current one despite having the correct address on file for her.
My dermatologist, hematologist, integrative medicine provider, endocrinologist, cardiologist, gynecologist, primary care provider, and gastroenterologist weren’t accessible via Perplexity. (And these are only a few of the providers whose data couldn’t be accessed by Perplexity.)
Note. Six of eight of the above aren’t accessible via Guava either, but I can upload those visit notes to Guava Health myself.
To only see 10% of the data can also limit seeing the big picture. So, I grouped the files using Adobe to upload them (after deleting each individual file that I had uploaded).
BUT if you’ve used AI to try to analyze data in large 150+ page files, you’ll know … it isn’t always easy. (Even Gemini tells me occasionally that my files are “too large”.)
The Administrative Demand
Then I had an interesting ‘conversation’ with Perplexity’s AI when I realized that despite syncing up with the API of one of my facilities with most of the lab data, it was missing specific data points (e.g., all Free T4 data after November 2021 despite that specific lab being drawn between 2-6 times/year.)
So I asked Perplexity Health’s AI where the labs are, and was told “You’re right that [FACILITY X] has them and that you uploaded them; the issue is that they’re not surfacing in the structured “labs/observations” stream I can see”. The AI provided several reasons for why those labs weren’t there:
They may be stored only as a scanned PDF/image of the ER report, not as discrete lab rows, so they don’t appear in the lab feed even though they’re in your chart.
The upload might be filed under “Media,” “Documents,” or an outside-records bucket that isn’t mapped into the lab/observation section my view is pulling from.
The interface that shares data from Facility X’s EMR to this aggregate view may not map ED lab panels from that date or that specific visit type correctly.
But as a patient, provider, or researcher, the issue for those of us using Perplexity Health is that those labs aren’t there, and even uploading them, doesn’t lead to them being added to the biomarker section of the site.
So when I asked Perplexity AI what I should do, it suggested that I call the hospital’s IT department to request they “re-index” my FHIR API mapping.
Fig. 2 Perplexity delegates technical labor to the patient; Guava automates the extraction through AI parsing.
Even when I provided the connections to the facilities and uploaded the records (labs and visit notes), which took A LOT OF TIME, I learned today from the Perplexity Health AI: “So even though those note sets exist in your health system, what’s flowing into this connection right now is the coded summary, not the full written note body”.
To get Perplexity Health AI to review the visit note (not the summary, the actual note), I had to reupload the visit notes to the AI side of the conversation so it could read those vs. the coded summaries.
With that in mind, Guava’s AI had me copy the line from the visit note that I wanted it to compare with my other visit notes. This is what Guava Health’s AI told me today: “I can review excerpts you paste here, but I can’t directly pull provider notes from your chart unless the app exposes them to me in this chat. If you want, paste the relevant sections”.
The Patient’s Reality
Asking a hospital’s HIM department to fix a third-party AI’s mapping is an exercise in futility. We don’t have the energy to act as unpaid data engineers for a Beta product that is already charging a premium. Also, what do you think the hospital system would say if I asked for this?
Help Desk Emails
I have emailed the help desk for Perplexity Health AI and Guava. Because I did so about the above issue with Perplexity Health AI at the suggestion of the AI after it realized it was missing significant biomarker data points, let’s address the difference.
Perplexity Health: AI Support Agent Sam emailed me back to thank me for my insights and saying that they forwarded my feedback about lab integration limitations, file upload limits, and suggestions to the product team. I sent the email April 14, 2026. I haven’t heard back.
Guava Health: This is one example of an email with the Guava Help Desk. I emailed Guava Health’s Help Desk and asked how to fix an issue when there were two sources for the same lab on August 7, 2025. On August 8, 2025, I received an email from Alex Yau, Founder and President of Guava Health to answer my question. He asked for a screenshot for an example, which I sent and he followed up with additional insight and added that he would forward it to his team to give more thought.
Note. Both Perplexity Health AI and Guava Health have discords. I am not in the Perplexity discord, but I am in the Guava Health Discord.
The Android OS Barrier
While iOS users have a native Hub, Perplexity is “desktop-primary” for Android users. Using a mobile browser to check your health data is clunky and lacks the seamless utility of a native app.
The Repository Advantage: DICOM, Quest, and GI Notes
Guava is a Source of Truth; Perplexity is a search window.
Imaging (DICOM): Guava supports actual X-ray, CT, and MRI image files. You aren’t just storing a “report”; you are carrying your entire imaging library in your pocket. (Note. You need to upload those, but, still.)
Medication Reconciliation: I manage 62 active medications. Guava allows me to merge and deduplicate them across providers. Perplexity was able to retrieve some medication lists from the facilities BUT some of those lists were outdated.
My understanding is that Perplexity Health AI integrates with Apple Health for medication management, but I use Android, so I cannot comment on that.
I can, however, comment on Guava Health’s Medication management:
Data Portability: The “Disability & Tax” Hack
The true power of a health platform is what you can do with the data.
The Guava Hack: I downloaded my encounter history from Guava and used Gemini (in thinking or data analysis mode) to generate a mileage CSV for my taxes and a total encounter count for other paperwork. Guava provided the “raw material” to simplify my legal and financial life.
Perplexity’s Failure: Because Perplexity couldn’t accurately aggregate my history, I question whether it could do so accurately.
I’ll talk more about this in another post.
Setting Health Goals in Perplexity
One of the most revealing disconnects in Perplexity’s “Health Hub” is the Health Goals feature, which feels fundamentally “un-Spoonie.” While the marketing suggests a personalized experience, the available goals are largely aspirational wellness targets—like “Improving sleep” or “Marathon training”—that assume a linear, healthy baseline.
For a patient managing chronic illness, these rigid targets are often inappropriate or even demoralizing, as they ignore the daily fluctuations in energy and capacity that define the “Spoonie” experience. In contrast, the Fitbit Beta with Gemini feels significantly more approachable; instead of assigning a generic wellness category, it begins with a conversation about your specific challenges and health conditions. This “Coach” approach allows the AI to adjust its insights to your actual reality, rather than forcing you into a “fitness enthusiast” mold that your body simply isn’t in today.
Taken from Perplexity Health AI. It felt like there should be an “other” option.
Auditing for Bias & The Privacy Trap
I decided to test Guava Health and Perplexity AI today on auditing visit notes for biased language from a specific former provider.
While Perplexity was helpful, I found that NotebookLM and Gemini were significantly better at finding subtle linguistic cues.
Guava Health had me copy and paste the lines from the visit note into the AI for analysis against my record, but the AI then gave me an excellent plain language overview of bias in the portion I provided it.
CRITICAL PRIVACY WARNING: Unless you have a signed BAA (Business Associate Agreement)—like Guava—BE AWARE that uploading sensitive records to any non-HIPAA compliant AI (e.g., Gemini via personal Gmail, NotebookLM attached to personal Gmail, ChatGPT, or Perplexity without the Perplexity Health piece) is only as secure as your cloud data/passwords/and more.
Final Verdict: Research vs. Management
Perplexity Health is charging a premium ($20/month) for a Beta product that requires the patient to act as a manual data entry clerk. It is for people who want to research a disease.
Guava Health is for people who have to manage one. Guava Health Premium is only $8 per month. And if your provider has a Guava Health Provider Dashboard and invites you to it, IT IS free for you. Guava Health also offers a free version to patients.
Use Perplexity if: You want a search engine for medical trends. (Maybe? But I still haven’t tested this out as much as I need to. I tend to use Google Scholar.)
Use Guava if: You need to manage medications, prepare questions for medical visits, quickly access provider notes, see overviews of your biomarkers, store your imaging, and have your data work for you in the real world.
COMING SOON:
How to get a copy of your evidence (certificate) of coverage
The Disability & Tax Guide: A step-by-step on using your medical data to navigate these two data heavy tasks.
The Provider Portal: How Guava helps your doctors help you.
Guava Tags: How I use custom tagging to find patterns in flares.
If you have questions about Guava Health, post them here!
Identification Note:Logos used for nominative fair use for critical review. Stephanie Nixon, PhD, CCC-SLP serves on the Guava Patient Advisory Panel pro bono. Review based on the April 2026 Beta of Perplexity Health.
Have you ever spent hours on a call with a provider or insurance company and then when you call back you’re told they have no record of the call? If so, you know how exhausting self-advocacy can be.
Managing healthcare for yourself or your family shouldn’t require a law degree, but keeping a detailed “paper trail” is one of the most important things you can do when disputing a bill, fighting for a prior authorization, or coordinating care.
As a patient and provider, I know that advocating for care and coverage is hard enough. So I am sharing a tool I made for me and my husband in January 2026: A Healthcare and Insurance Communication Log. (See my last post for more information.)
This tool was made primarily for dealing with health insurance (including our pharmacy benefit manager).
What is it?
A simple, customizable Google Form that you can fill out on your phone or computer during or immediately after a phone call. Use it to track:
Date and time of the conversation
Who you spoke to
What you discussed
What your next steps (and their next steps) are
And more…
You can quickly reference the key information needed from previous calls by looking at the entries in the form: (e.g., name of who you spoke with, company they are with, and date/time of the last communication, what was said, etc.).
A Quick Word on Privacy: Share the Tool, Not Your Data
If you find this call log helpful, we absolutely want you to share it with your friends, neighbors, or online support groups! However, it is crucial that you share the tool safely.
Because your copied Google Form is tied directly to your personal Google account and your private spreadsheet, sharing your specific form link outside of your immediate family (more specifically those involved in your healthcare and health insurance decisions).
If you send someone your personal link to copy for their own use, you will accidentally give them access to your Protected Health Information (PHI) and private medical notes.
The safe way to share:
The safe way to share: If you want to recommend this tool to someone else, do not share your Google Form link. Instead, simply copy the web address (URL) of this blog post and send that to them! This ensures they can read the instructions and download their own clean, private template that is completely separate from your data.
Disclaimer:
The Short Version: (Simply put)
This is just a helpful tool: This tracker is a free organizational aid, not official medical or legal advice, and downloading it does not make you a patient of Nixon Speech and Language.
This tool does not set reminders for you.
You are in charge of your data: The information you type goes straight into your personal Google account, not ours. You are responsible for keeping your own account and passwords secure.
Be mindful of privacy: Free Google accounts are not strictly protected by HIPAA (healthcare privacy laws). Please be careful about typing highly sensitive information (like Social Security numbers) into the form, and make sure you track strict insurance deadlines on your main calendar, too.
Share the tool, not your data. Share the link to the blog to help your friends, not your own form.
Longer version
Please read before downloading: This form is a self-help organizational tool provided courtesy of Nixon Speech and Language, LLC. It is not a medical device, a legal record, and does not constitute professional medical or legal advice, nor does it establish a provider-patient relationship. Do not rely solely on this form for critical deadlines. By downloading this template, you acknowledge that you are the sole owner of the data entered and assume all responsibility for securing your personal Google account. Standard, free Google accounts are generally not HIPAA-compliant environments, so please exercise caution when entering highly sensitive Protected Health Information (PHI).
By downloading this template, you acknowledge that you are the sole owner of the data entered and assume all responsibility for securing your personal Google account. Standard, free Google accounts are generally not HIPAA-compliant environments, so please exercise caution when entering highly sensitive Protected Health Information (PHI).
How to set it up
Make your copy: Click the link at the bottom of this post and select “Make a copy.”
Customize your form: Open your new form and edit the placeholder text.
Change the “Who was the call about?” question to list your specific family members.
Update the “Which organization did you contact?” question to list your main contacts (e.g., Blue Cross, Aetna, CVS Caremark).
Publish the form. Be sure to copy the link after publishing for your use.
Save it for easy access:
Fillable form: Bookmark the link to your fillable form on your computer (in Google Drive), or save it to your phone’s home screen so you can have it ready to complete during your next call.
Bookmark the file used to create the fillable form: This is where you’ll find all your call logs. You can print (or PDF) specific responses or export all responses to sheets.
Be sure to hit submit when you finish the call. If you don’t, your call log won’t save.
💡 Pro-Tip: Make it a Household Effort!
If you share healthcare duties with a spouse, partner, or adult child, you can use this single form to track everyone’s calls in one central place!
Once you have copied the form to your Google Drive and customized your family’s names, simply click the purple “Send” button at the top right of the screen. You can email the link directly to your partner, or copy the link and text it to them.
Have them save that link to their phone’s home screen. Now, whether it’s you calling the PBM about a prescription or your spouse calling the provider about a bill, all of your notes will feed into the exact same spreadsheet. No more asking, “Wait, what did the insurance rep tell you yesterday?”
The following applies only to those you want to share access to protected health information: If they need to be able to reference all calls for your household/family, be sure to share the backstage link AND fillable form.
📱 Make It an “App” on Your Phone
The easiest way to use this log is to save it directly to your phone’s home screen. That way, you don’t have to dig through your Google Drive every time you make a call.
First, get your fillable link: Open your form on your computer, click the purple “Send” button at the top right, click the link icon (the little chain), and copy that link. Email or text that link to your phone, then follow these steps:
For iPhone (Safari):
Open the link on your phone using the Safari browser.
Tap the Share icon at the very bottom of the screen (it looks like a square with an arrow pointing up).
Scroll down the menu and tap Add to Home Screen.
Type a short name for it (like “Insurance Log”) and tap Add in the top right corner.
For Android (Chrome):
Open the link on your phone using the Google Chrome browser.
Tap the Menu icon in the top right corner (the three vertical dots).
Scroll down and tap Add to Home screen.
Type a short name for it (like “Insurance Log”) and tap Add.
Now you will have a shiny new icon on your phone right next to your other apps. Just tap it whenever you are on a call!
📂 How to View Your Call History (The form and spreadsheet)
Think of your Google Form like a restaurant. The shortcut you saved to your phone is the “Front Door”—it’s just the menu where you place your new order. To see the history of every call you have ever logged, you have to go “Backstage” into your Google Drive.
Here is how to find your notes:
Go to your Google Drive: On a computer, go to drive.google.com and log in with the exact same Google account you used to copy the template.
Open the “Backstage” File: Find your saved form (e.g., “Healthcare Communication Log”) and double-click to open it. This opens the Editor view.
Click the Responses Tab: At the very top center of the screen, click the word Responses (it is right next to “Questions”).
Create Your Master Spreadsheet: For the best view, look for the little green icon that says “Link to Sheets” (or “View in Sheets”) near the top right of the Responses section.
Clicking that green button will instantly generate a clean, organized Google Spreadsheet containing every single detail of every call you have ever submitted.
📄 Need Hard Proof? How to Save a Call as a PDF
If you are filing a formal appeal or need to prove exactly how many times you contacted your insurance company about a specific issue, you can export individual call logs as clean, printable PDF documents.
Here is how to do it:
Go “Backstage” into your form and click the Responses tab.
Instead of looking at the spreadsheet, click the Individual tab (located right next to “Summary” and “Question”).
You will see your form filled out exactly as you submitted it. Use the < and > arrows to flip through your history until you find the specific call you need.
Click the Printer icon at the top right corner of that specific response.
When your computer’s print menu pops up, change the “Destination” or “Printer” from your physical home printer to Save as PDF.
Now you have a professional, timestamped document you can attach directly to an appeal letter or an email to your provider!
Get the template
Ready to get organized? Click below to copy the template to your Google Drive:
Please read before downloading: This form is a self-help organizational tool provided courtesy of Nixon Speech and Language, LLC. It is not a medical device, a legal record, and does not constitute professional medical or legal advice, nor does it establish a provider-patient relationship. Do not rely solely on this form for critical deadlines. By downloading this template, you acknowledge that you are the sole owner of the data entered and assume all responsibility for securing your personal Google account. Standard, free Google accounts are generally not HIPAA-compliant environments, so please exercise caution when entering highly sensitive Protected Health Information (PHI).
By downloading this template, you acknowledge that you are the sole owner of the data entered and assume all responsibility for securing your personal Google account. Standard, free Google accounts are generally not HIPAA-compliant environments, so please exercise caution when entering highly sensitive Protected Health Information (PHI).
Remember, share the post, not your data.
By clicking here you acknowledge that you have reviewed the disclaimer.
Information provided in this post by, Stephanie M. Nixon, Ph.D., CCC-SLP, is provided in good faith. Nixon Speech and Language, LLC makes no representation or warranty of any kind, express or implied regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any information.
Stop scribbling on scrap paper. Here is the exact system I use to hold insurance companies accountable (and keep track of what has been said).
In my last post, I talked about the importance of documenting every single interaction with your insurance company. But let’s be honest: when you are managing a chronic illness, working, or just living life, finding a notebook and a working pen while on hold is just one more hurdle.
My husband and I realized early on that we needed a system that was fast, shared, and impossible to lose.
Our solution? A simple Google Form.
It lives as an icon on our phone home screens. When we get on a call, we tap it, fill in the blanks while we talk, and hit submit. It automatically saves everything into a spreadsheet that we can search later.
Why This Works Better Than a Notebook
It Prompts You: You never forget to ask “Who am I speaking with?” because the form requires you to type it in.
It’s Collaborative: If my husband takes a call, I can see the notes instantly on my computer. No more “Did you call them?” arguments.
It Creates a Timeline: When you need to file a grievance (like I did), you just open the spreadsheet and copy-paste the entire history.
The Fields You Need (Steal My Form)
I created a free Google Form with these specific questions. You can copy this exact structure:
Patient calling about: (Checkbox: … Names of those in the household, etc.)
Date called: (Date picker)
Who contacted? (Checkboxes: Benefits, Care Management, CVS Caremark, HR, etc.)
Method of contact: (Checkboxes: Phone, Email, Secure Message)
Did I record the call? (Yes/No – Check your local lawsas many areas require you to ask permission to record.)
My Script: “I need to record this call so I have a record of what to do next. Do I have your permission to record?” Note. Be sure to note this to any new call participants.
Note: If they say “No,” I immediately ask: “Since you are recording this for quality assurance, can I request a copy of that recording for my records?” (This usually changes the tone of the conversation!)
Name of representative: (Crucial! Always ask for this first)
Reason for call: (e.g., Prior Authorization, Billing Error, Benefits Question)
Summary of call: (What did they say? What did you say?)
How long were you on the call? (This is important evidence for complaints)
Action items: (What did the representative promise to do? What do you need to do?)
Follow-up date: (When should you check back?)
Header for your form.Settings for the form. Some are personal, but this let’s me and Josh know who entered the data.I have the email addresses required by default and the same for questions. (You can set some as not required.)
How to Set It Up
Go to forms.google.com and click “Blank Form.”
Add the questions listed above.
Click “Send,” copy the link, and email it to yourself and your spouse/caregiver.
Pro Tip: Open the link on your phone, tap “Share” (iOS) or the menu dots (Android), and select “Add to Home Screen.” Now it looks and acts just like an app.
The Result
When my pharmacy billing nightmare happened, I didn’t have to rely on my foggy memory. I opened my spreadsheet and saw exactly who disconnected on me on January 29th, and exactly what “Curtis” told me on February 6th.
That data wasn’t just notes; it was evidence. And evidence is the only thing that wins insurance appeals.
Disclaimer: I am a Speech-Language Pathologist and person with chronic illness, not an insurance broker or attorney. This post shares my personal experience and is not intended as legal or financial advice.
A real-life lesson in why you must audit your Explanation of Benefits.
We often assume that when the pharmacist rings up a total, or when a medical bill arrives in the mail, the number is correct. We assume the insurance computer “knows” our plan.
But we also know that the insurance computer (and even the claims processors) have a history of applying the plan incorrectly (or inconsistently).
In January I had accepted that the “computer” knew our new plan for our prescriptions —and it nearly cost my family over $1,300 in a single month.
Image created by Nixon Speech and Language, LLC using Adobe Firefly AI.
From Advocate to Patient
For years, I essentially worked two jobs. By day, I was a Speech-Language Pathologist working full-time. By night, I often spent three hours at a time, multiple nights a week, on the phone with insurance companies fighting for my own coverage. I learned early on that whether you are an educator advocating for a student, provider advocating for a patient, or a patient advocating for yourself, the system will often default to “No” unless you prove otherwise.
Now, living with chronic illness and on long-term disability, I no longer have that kind of energy to spare. My “work” today is largely just managing my own health. So when a computer glitch recently caused our pharmacy bills to skyrocket, it wasn’t just a financial error—it was a drain on the limited energy I have to survive.
I’m sharing this story not just as a professional who knows the paperwork, but as a patient who knows the exhaustion. I want to help you catch these errors quickly so you don’t have to spend your evenings fighting for the coverage you’ve already paid for.
The “Glitch”: When the Math Doesn’t Math
The “Glitch”: When the Math Doesn’t Math The situation started simply enough: My husband went to pick up a routine prescription. Instead of his usual $60 copay, he was charged $807.
The explanation from the pharmacy? “You haven’t met your deductible yet.”
That sounded plausible. It was January, the start of a new plan year. But when I logged into my portal, I saw something even stranger.
I had paid over $1,000 for medications in January, but my “Deductible Met” counter was sitting at $0.
Where did the money go? The system had bypassed the deductible entirely and applied the cash directly to my “Max Out-of-Pocket” limit.
The Error: They were charging me full price (as if I had a deductible), but refusing to credit my deductible bucket.
The Result: I was on track to pay thousands of dollars out-of-pocket without ever technically “meeting” my deductible. It was a phantom charge that left me with the worst of both worlds: high costs and no progress toward my coverage limits.
This is what an error looks like. My plan has a $0 pharmacy deductible, yet the system charged me over $500.
The Domino Effect: Why You Can’t Just “Let It Slide”
You might be tempted to just pay the overcharge to avoid the hassle. I understand that urge completely. But here is the trap: Insurance systems use something called an “accumulator.” It tracks how much you’ve paid toward your deductible.
If you pay a deductible that you don’t actually owe, the system “learns” the wrong information. Later, when you see a doctor or go to the hospital, their claims might get stuck or rejected because the math doesn’t add up. By fixing this one pharmacy error, I wasn’t just saving money on a prescription—I was unblocking thousands of dollars in medical claims that were stalled in the system.
The Hidden Trap: When the pharmacy system sends the wrong data to the medical system, it freezes your processing medical bills.
Red Flags: How to Spot an Error
Unfortunately, we had already paid for the medications. Although the error was corrected in the “Carefirst” and Caremark.com com systems as of February 2, 2026 (excepting my order receipts), we did not receive a refund or even notification that a refund was due.
In fact, after speaking with several representatives this week it seems the “correction” was backdated; however, neither Caremark nor the local pharmacy where we bough a medication were told we were owed refunds. Our local pharmacy credited us the money for their end, now I am trying to get a refund from Caremark.
Here is how to know if you should question a charge:
The “Deductible” Surprise: If you have a PPO or HMO, your prescriptions usually have flat copays (e.g., $15, $30, $60) that apply immediately. If you see the word “Deductible” on a pharmacy receipt, check your plan design.
The “Phantom Payment”: Check your insurance portal after a big purchase. If you paid $500 at the pharmacy, your “Deductible Remaining” should drop by $500. If the money disappears into the ether (or only hits your “Out-of-Pocket Max”), the system is miscoded.
The “Processing” Limbo: If your medical claims (doctor visits) are sitting in “Processing” for weeks, it often means the medical system is waiting for the pharmacy system to send data that—thanks to this glitch—will never arrive.
The plan thought we were in a different plan type offered by my husband’s group, a CDHP plan, but we are in the plan above.
Strategy: Write First, Call Second
The Reality: Phone calls are exhausting. But sometimes, secure messages result in frustrating, boilerplate responses that don’t answer your question. (I received a generic reply about “brand name drugs” that had nothing to do with my actual billing error!)
My advice: Even if you know you’ll have to call, send a Secure Message first.
It creates a legal timestamp. Even if their reply is useless, you have proof that you reported the error on “Date X.” They can no longer say, “We have no record of that issue.”
It forces a written response. When you finally do get a human on the phone, you can cut the small talk: “Please open Case #12345. I have already submitted the details in writing.”
It respects your energy. If you have to file a formal legal grievance later, showing that they ignored your clear written explanation makes your case much stronger.
In my Caremark secure message center. There is also one for your health insurance company.
Pro-Tip: Document Like a Clinician
When you are dealing with brain fog or fatigue, relying on memory is risky. I treat every insurance interaction like a patient case note.
Log Everything: Date, Time, and the Representative’s Name.
Ask for the Reference Number: Every call has a “Case ID.” Ask for it immediately.
The “30-Day” Clock: If they say they will “review it,” mark your calendar for exactly 30 days later. If they haven’t fixed it, they may owe you interest.
See my post on creating a “patient’s log” that may help you track who said/did what (and when)
The Magic Words to Use
If you do have to speak to someone, use these terms to get past the front-line script:
“Plan Design Error”: This tells them the computer is set up wrong for your specific group.
“Adjudication Breakdown”: This asks for the math behind the price (e.g., how much was copay vs. deductible).
“Accumulator Adjustment”: This asks them to fix your deductible history so future claims process correctly.
“Senior team”: If you have already worked with the senior team on your issue, then explain the time it has taken and ask for the appropriate representative
The Takeaway
It took weeks of persistence, but we finally got a break. A representative worked with our local pharmacy on one claim and we were refunded for the discrepancy that was initially erroneously classified “deductible” ($747 of the $807.07 prescription cost). The call was disconnected before he could let me know how he was managing the issue with the Caremark pharmacy payments, but we have the proof we need to win.
I spent years advocating for others. Now, I’m learning that the most important advocacy is often the kind we do for ourselves—quietly, methodically, and with the receipts to prove it.
Disclaimer: I am a Speech-Language Pathologist and educational consultant, not an insurance broker or attorney. This post shares my personal experience and is not intended as legal or financial advice. Always consult your specific plan documents for coverage details.
Stephanie M. Nixon, Ph.D., CCC-SLP January 29, 2025
The power of a name, label, or diagnosis – even the name of a symptom
What’s in a name? A label? A diagnosis? Does knowing a diagnosis grant us power? Does it provide the knowledge we desire when confronting a situation (not just learning disability or health-related)?
When I wrote about this years ago in my undergraduate thesis about Egyptian religion, I noted the similarity between naming gods and goddesses who “controlled” various aspects of life (love, weather, sun, rain, etc.) and naming hurricanes. I know this is over simplified in some ways, but there is a parallel.
“Sometimes naming a thing — giving it a name or discovering its name — helps one begin to understand it. Knowing the name of a thing and knowing what that thing is for gives me even more of a handle on it.” — Octavia E. Butler, Parable of the Sower
Thinking about what Octavia E. Butler said above, it makes sense (at least to me). It helps to just understand sometimes. And other times, it might bring a “fix”. Granted a often there isn’t a “fix” or “cure” for learning disabilities or chronic illnesses or even natural disasters. i.e., It’s not always just here, take this medication for 10 days and you’re all better. (I wish it was that easy…)
For ADHD and autism, there are no cures but there are treatments and there is understanding.
For chronic illnesses like my diagnosis of Hashimoto Thyroiditis, often there is no cure. You might need to take a medication daily depending on your doctor’s advice. Some chronic illnesses are even progressive. Some are merely described via symptoms, but we cannot “cure” it.
For natural disasters, we cannot stop the hurricane from hitting an area, but we can prepare for it. And we can provide disaster relief afterwards to help an area recover
What have I seen, personally and professionally?
As a practitioner, I sometimes patients/caregivers wanted a diagnosis and others wanted the descriptor and support. For adult and pediatric patients, a label can help with insurance coverage. For pediatric patients, a label (i.e., a diagnosis – even working diagnosis, e.g., autism, dyslexia, etc.) can help with access to special education services and accommodations and insurance coverage for services.
As a patient, adding the diagnosis of autism to my long-time diagnosis of ADHD helped me understand those feelings of overwhelm from too much noise, too many “things” coming at me, and much more. Has it “fixed” the situation? No. But it gives me grace in those moments or even afterwards when I can recognize the link to “autism”. (I recognize this won’t apply to everyone. Some people find hearing the actual diagnosis scary.)
What’s in a name?
When it comes to chronic illnesses (even acute), speech and language disorders, learning disabilities, autism, ADHD, and more, we as patients (and even practitioners) often want to know the diagnosis/name. We want to understand what we’re dealing with. But why?
Empowerment, knowing how to prepare, find options, and find ways to cope (social groups, etc.)
Validation, knowing what we feel/see is happening, someone else sees it
Understanding, understanding of ourselves and what we need and for parents of a child, understanding of a child’s needs
Forgiveness of ourselves (our children and loved ones where applicable), knowing a “diagnosis” can help a person recognize how the diagnosis affected a situation and forgive themselves or another for this. (I’m not saying a diagnosis is an excuse! I’m saying, it can give that allowance to make that mistake.)
Access, having a diagnosis or adequate symptom description can give access to accommodations, insurance coverage, and research studies that are otherwise unavailable. (e.g., For pediatric speech-language therapy, many private insurance plans have exclusions saying that services are only covered in cases of accident, injury, stroke, or autism spectrum disorder.)
What do many patients want?
As a patient, I want to be heard. I want to be validated. I am living this life, not the practitioner. I want that practitioner to treat me like I treated my patients, which is to listen, genuinely listen. Don’t discount what I’m telling you because you aren’t seeing it in this moment at this time.
When I saw patients, I tried to remember, treat them like I wanted to be treated. Yes, they may want the why, the cure, the fix, but I did my best to explain what I saw and next steps. And hear their responses and consider them in light of what I saw in that 2 hours in my office.
And of course there are times we may find nothing definite, but we can validate their experience. We can listen. We can recognize when there is something off that just may not be recognized by available tests.
There are many times that there isn’t an exact diagnosis. We can describe the symptoms and those might even have “diagnosis codes” in ICD-10, but we may never know the overarching “cause” for those symptoms or if there is one. BUT, even describing the symptoms and assigning ICD-10 codes provide a “name”.
Like many of my families and patients I have had over the years, I have navigated the waters of the unknown with my health and learning. I know how scary those waters can be. I know there isn’t always an answer, but my objective is to benefit others with my knowledge and experience. Even if it’s just how to navigate healthcare systems or health insurance or a diagnosis/symptom.
More recently, I decided to record some of my symptoms and post them to YouTube to share the journey with others. My hope is that professors, practitioners, and patients can benefit from these in some way.
Would I like to know a cause? A name? A diagnosis? Who wouldn’t? BUT – even if I can’t learn that information – if I can benefit others, then in my opinion I won.
Thoughts for providers
Providers, if you are frustrated by patients seeming “hung up” on getting that “label”, it’s for the reasons I said above. What can you do?
Respect the request – and try to understand
Sit in their shoes a minute
Ask the patient/family why they seem to “want” the diagnosis
Consider whether they experience something you may not see in your office
Use your active listening skills
Consider reviewing the data and scheduling a follow-up
Avoid assuming you know more about that patient than the patient/family (you only see them for that short period in your office)
Empower them to help you see what they see
Ask if there is an insurance reason they need a diagnosis
Consider whether the person could benefit at minimum from an acting diagnosis (if appropriate) to give them access to care that would otherwise be denied
Ask them how what they report is different than previous function (if appropriate)
Ask how it is affecting them in daily life
Tangent. Consider a patient’s background during the appointment
If that patient is an allied health professional trained in the area they are coming to you about, please pause and consider that this patient may be using every tool they know to minimize the effect of their concern in your office. Listen. Think about the tools they might have – objective tools (like a measure of grip strength for OTs) – that you don’t.
An example from many years ago
Over 10 months from 2010 and 2011, I went through over 20 rounds of antibiotics for respiratory infections before seeking a pulmonary doctor. Finally, I went in. My voice was hoarse from all the coughing. I told the doctor (who will remain nameless) that I was going to lose my voice. I asked for someway to help the cough so I wouldn’t lose my voice. (Try being an SLP with no voice.)
The doctor told me I wouldn’t lose my voice. I reminded her of my training. I reminded her of my specialty. I was dismissed. I was in tears trying to explain myself to her.
Fast-forward. The sputum culture returned. It was Methicillin Sensitive Staphylococcus Aureus. I was given an antibiotic. But due to coughing, I lost my voice 24 hours later. I did not regain enough voice to return to work for at least 3 weeks. (Even when I returned, I barely had enough voice to talk through the day.)
I saw an ENT who specialized in voice, who said I had an ulceration on my vocal folds from coughing.
To patients and practitioners
I understand the frustration from both sides. I’ve been there. I’m there right now. I know how scary the unknown is, but let’s work together. Let’s listen.
Practitioners, involve patients who want to understand when reviewing their case. Don’t hesitate to say “I don’t know” or “I need to go look that up”. Just be sure to get back to the patient later.
Patients/families, I know the information is sometimes overwhelming. Don’t hesitate to pause the practitioner, repeat what they said, and as if you understood. As for a list of action items. And tell the practitioner if you have any barriers to accomplishing those items (even time to make those phone calls). Find out how to contact your practitioner. You deserve someone who will listen and advocate for you.
So…again, what’s in a name, a label, a diagnosis? It can be more than a provider might know from access to understanding. Validating a symptom observed goes a long way, especially if that has an ICD-10 code – even if there is not treatment available. And that ICD-10 code is something researchers might look up in the system in the future and look at associated health conditions which could lead to better understanding and treatments.
Yes, that might be a long way off, but again, for someone like me who just wants to help others, I don’t care if it’s 100 years off. If my data helps practitioners and patients learn about health conditions, then I will view it as a win.
Disclaimer. This article is based on personal and professional experience as well as research on counseling patients. This information is not intended as legal advice or healthcare advice. Please see a provider about any healthcare needs. I acknowledge that some people need different approaches than others when receiving information, so again, providers use your informed clinical training and judgment.
medical gaslighting and the importance of accurate, data-driven medical records for neurodivergent (AuDHD) patients." class="wp-image-967" srcset="https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-1024x1003.png 1024w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-300x294.png 300w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-768x752.png 768w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-1536x1505.png 1536w, https://nixonspeechandlanguage.com/wp-content/uploads/2026/05/Case-Study-Bias-in-chart-notes-2048x2006.png 2048w" sizes="(max-width: 1024px) 100vw, 1024px" />
Leave a Reply