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.
Note. This is an updated version of an article I wrote in 2021 for Apraxia Kids. The main reference was to childhood apraxia of speech research, but this applies to research across the sciences.
Some current (2025) actions by the executive branch make information of utmost importance. Some changes threaten sources of independent research funding.
What is evidence-based practice?
You may have heard speech-language pathologists (SLPs) saying “evidence-based practices” when describing a specific treatment approach. Such practices are based on scientific evidence and professional experience while considering your child’s specific needs.
Scientific evidence is used by SLPs, educators, and medical professionals (among others) to guide interventions and strategies could help a person based on their specific needs.
There is not one approach that works for all people, especially not for all children with childhood apraxia of speech (CAS). There are some approaches that have not been studied at all or have been studied with research methods that don’t allow for very strong conclusions.
What is scientific evidence?
Scientific evidence is empirical data that is collected and interpreted using the scientific method. This is evidence that serves to support or counter a scientific theory or hypothesis and is derived from controlled studies.
Is all scientific evidence high quality?
Simply put, no.
Well-designed research studies are more valuable tools than an anecdotal opinion.
What are the levels of evidence?
Additional information about evidence-based interventions as defined in the Every Student Succeeds Act (ESSA) from the California Department of Education.
Let’s summarize…
The lowest form of evidence = opinions based on “experience”
Best form of evidence = pulling multiple randomized controlled trials into guidelines or a meta-analysis
Anecdotes are not evidence especially when these anecdotes are offered by (or on websites of) people/companies with a commercial interest.
Note. Researchers/organizations obtain grant funding by applying. Even then, there is a review process to determine whether they receive the funding.
Applications are peer reviewed by field experts who determine whether the application meets the criteria among other standards.Why does commercial interest matter in speech-language pathology or education?
What is a commercial interest? Earning money by selling a product OR saving money by not providing a service. (The latter is more relevant to health insurance – at least for now.)
Example: Dr. Blah at company XYZ creates and markets a program to teach math. If it is sold to school districts, then they will make money. Now if XYZ and Dr. Blah are the only ones who research the program they are more likely to determine this “works”.
What can decrease the quality of evidence?
Specific to CAS treatment research studies, look for study limitations (e.g., small sample size, inconsistent implementation of treatment approach, lack of a control group or condition, pre-treatment differences between groups, analysis performed by non-blinded outcome assessors, etc.).
Do we have much of the Level 1 standard research for Childhood Apraxia of Speech treatment?
No. We have a few meta-analysis studies and systematic reviews available.
Here are some systematic research reviews (most summaries by the American Speech Language Hearing Association in their Evidence Maps):
Murray, McCabe, and Ballard (2014) concluded that of the research articles they analyzed, at least 3 treatments had sufficient evidence for Phase III clinical trials. Those treatments were Dynamic Temporal and Tactile Cueing (DTTC), Integrated Phonological Awareness, and Rapid Syllable Transition Treatment.
Ng, McCabe, et al. (2022) found an evidence base for the use of Rapid Syllable Transition Treatment (ReST).
Springle, Breeden, et al. (2020) found limited higher dose and frequency of motor programming treatments appeared most effective for children with CAS.
SLPs can look at the “evidence” to determine which approaches are most likely to work. The evidence includes the research available and the patient’s unique needs.
What characterizes a strong treatment research study?
Diversity in the population? (i.e., Gender? Race? Ethnicity? Primary language? Age – depending? Diagnoses? Socioeconomic status (SES)? Geographic location? Gender identify and expression? Disability status?)
Why do we care about diversity in the sample ?
Simply put: Inclusivity matters. The linked 2023 article by Alice McCarthy details the need for inclusive clinical trials.
Yes, we’re dealing with speech-language therapy trials vs. drug trials; but, that doesn’t change the need to ensure a representative population. This might advise a research of possible barriers to care as well as how to address the barriers.
Randomization: There are many types of randomization as described in the article linked (Lim & In, 2019). Randomization helps researchers eliminate/minimize accidental bias (including selection bias).
e.g., We want to ensure that patients weren’t chosen to receive the “treatment” group merely because they seemed to have more or less speech sound errors.
Bias in research
Bias in research is beyond the scope of this article. If you’d like to learn more, here is one journal article by Pannucci and Wilkins (2010).
Internal consistency indicates that several items measuring the same idea generate similar responses.
External consistency is the degree to which results are consistent with prior research.
Specific to consistency of analysis, we want to know how reliable were measures of patient performance. What was the level of agreement between/among therapists? How about a novel therapist?
Were the control and treatment interventions provided as intended? For example, did the SLPs administering the interventions stay within the guidelines provided by the research study? Did they introduce any concepts not included in the study?
Was the same modality of treatment used across patients in each condition? (in-person, telehealth, etc.)
Example.
(1) SLP working with a child in the “control” group includes some of the techniques from the “treatment” being tested and child shows progress in the “control” intervention.
Does this mean the “control” intervention works? No. It means the SLP did not follow the research protocol in the “control” intervention.
(2) SLP working with a child in the “treatment” group includes techniques beyond those described by the researchers as part of the treatment program (e.g., visual aids, cues, etc.) and the child shows progress with the “treatment” intervention.
Does this mean the “treatment” intervention works? No. It means the SLP did not follow the research protocol in the “treatment” intervention.
Other important factors
We also need to consider the presence of other factors that could explain improvement or regression (including whether these were controlled in the study). and whether these are controlled (e.g., if a child also received treatment elsewhere, or if a child started school, or had a medical procedure).
Was the child receiving treatment beyond that supplied in the study?
Did the child start school while in the study?
Did the child experience any medical changes during the study? (e.g., new medication, surgical procedure, new diagnoses, accident, etc.)
Maturation(i.e., getting older) is another factor to consider when reviewing treatment studies. That is, did the treatment group improve beyond what would be expected based with aging.
What if one approach with research support isn’t working for my child?
Well, if you have that concern, ask the practitioner. Practitioners usually track progress so they know when they need to adjust intervention (i.e., when the approach is not effective for the patient or when the patient masters an objective, etc.).
As a clinician, I ask myself these questions when an approach doesn’t seem to be “working”?
How long have we tried the approach?
Am I implementing the approach correctly? (It helps to review the approach.)
Is the child engaged (i.e., attending) with us during our sessions?
How consistent is the child’s attendance?
Have we provided appropriate family education (if included) with the approach? (This includes home practice)
Sometimes an approach just isn’t the best option for a child (and their family) and we need to adapt. This could include modifying the approach slightly to adapt or even changing approaches to one more suited for the child.
Regardless, an approach should have an evidence base, even if it was only demonstrated in a “single-subject design case study”. This allows SLPs to generate ideas/hypotheses (sophisticated educated guesses) about what might work for a given child.
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.
Information provided here is for informational purposes only.
This material is not substitute for professional medical advice or treatment. Always seek the advice of a qualified professional with any questions you may have regarding conditions and treatments/therapies. Do not delay seeking professional medical or educational advice/evaluation or delay seeking it because of something you read on this website.
See these websites for more information about evidence-based practices and research:
In honor of Dyslexia Awareness Month, here is a 1993 article, Dyslexics Overcome Barriers, that I wrote for my high school newspaper.
I interviewed some of the students at school who had dyslexia as well as some of the teachers who were trained in Alphabetic Phonics (an Orton Gillingham based program) and worked with the dyslexic students.
Dyslexics can provide so much insight into their challenges as well as ways to support them, but so often it seems they aren’t asked for their insight. I’ll go over this more in a future blog, but for now, just consider what these students said in 1993.
Disclaimer. This article is from 1993. The knowledge base about dyslexia has expanded much since that time. This post is only to provide historical insight not diagnose or treat.
Rebecca Warner from pqbd.org allowed me to turn the symbol she created for dyslexia into an emoji! I added it to the access and advocacy discord hosted by Nixon Speech and Language, LLC, but we would love to share this with those who have or know someone who has dyslexia!
Android Phone Directions
Save the file to your phone and/or a cloud drive you can access with your phone
Start a text to someone and select to use an emoji
Select create
Select folders
Select browse
Select the file
It will post it to the person you’re texting, but as you can see in the image, it is useable as a react to a text!
iOS 18 Directions
This description is taken from Google AI Overview. If someone could send me screengrabs as they create the file, then I would be grateful!
My understanding is this is only available for iOS18, but if you learn otherwise, please comment below!
Gmail and Google Workspace Directions
Within gmail, open google chat
Select emoji
On the right, select create
Upload the image file
Name it pqbd dyslexia
Now you can use the file in your emails and chats!
Note. For Google Workspace, staff need permissions to “create” new emojis. So, if you are unable to create one following these instructions, then ask a network administrator.
Thank you to Rebecca Warner and pqbd.org for making this symbol available to everyone!
Rebecca Warner is a 2012 founding member of the Virginia chapter of Decoding Dyslexia, DDVA. Active in legislative efforts in the VA General Assembly as well as a co-host for DDVA meetings, her experience includes speaking engagements, fundraising, and events. Owner and designer of the dyslexia symbol pqbd ®, she advocates for awareness and training in dyslexia both on a national and international level with projects that include the Dyslexia Friendly Library, Police National Dyslexia Association in the UK, Learning Disabilities Conference Japan, Dyslexia Organization Kenya, and the marketing committee for Riverside School. Most importantly, she is the mother of two neurodiverse sons, a dyslexic junior at Rose-Hulman Institute of Technology and an ADHD sophomore at the University of Virginia. She and her husband live in Richmond, VA.
You know those moments you wonder whether others have dealt with the challenge you (or anyone you care about) are facing? Maybe they have an idea you haven’t thought of? Or maybe you just don’t know what to do next?
We can learn from each other by sharing information, particularly when it comes to disability access and advocacy. To improve outcomes for individuals facing those barriers, we need to bring the stakeholders to the conversation.
To get these conversations started, I have started a discord. I know some people may be less familiar with discord, so don’t worry, I’ll do my best to guide those who don’t have discord yet.
Some quick notes that will help you get started:
Joining as an individual/caregiver? I’d recommend NOT using your real name or picture just to protect your privacy. I have information about this in the channel called “Setting up a Discord Profile”
Joining as a professional? (Educator, provider, advocate/attorney) If you are representing your profession, then use your name. (If you have a gaming discord though, you may want to create a discord account specifically for professional purposes.)
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