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?
The following post is based entirely on my personal experience navigating the DC Government CareFirst BluePreferred PPO Plan and its Pharmacy Benefit Manager, CVS Caremark.
I am a healthcare professional and a patient, not an attorney or an insurance broker. This is NOT legal or financial advice. While I make no guarantees about the results of using these methods, my goal is to share my knowledge, documentation strategies, and experiences so you can better advocate for your own health.
Any information from conversations with CVS Caremark or CareFirst comes from my notes taken during the calls in my ‘patient’s log’ as described in my blog. These notes were taken contemporaneously to ensure an accurate, time-stamped record of the instructions provided to me. All references to contractual rights are drawn directly from the governing CareFirst Blue Preferred PPO Evidence of Coverage Document.
Specific to the Certificate of Coverage (Evidence of Coverage), a CareFirst employee provided it to me when I was unable to obtain a copy from DCHR. If there is mismatch between the version I have and the version with DCHR, well that’s for another post. (Stay tuned.)
Please note: I currently have a formal grievance regarding this matter under active review with the District of Columbia Department of Insurance, Securities & Banking (DISB; DCID#: 2065134). I have also contacted the DC City Council and Mayor’s office.All regulatory violations discussed below are alleged based on my documentation, and I will provide an update once I receive a final disposition.
The Tech Black Hole: Where Prior Authorizations Go To Die
If your doctor tells you they are waiting on your insurance, and your insurance tells you they are waiting on your doctor, someone is lying. Actually, it’s probably the software.
I tracked a pattern across five medical specialties (including neurology, gastroenterology, rheumatology, and my PCP). Providers were submitting prior authorizations through a vendor portal called CoverMyMeds. The system would tell the pharmacy the request was “sent,” but the providers never received the questionnaires. After 48 to 72 hours, the system automatically closed the files for “no response”.
This is a de facto denial of benefits without clinical review, likely caused by a software defect. I realized something was off in December 2025 when I was still with Aetna, but I thought it might just be the facility.
When providers had the same trouble in January 2026 with the same result, I realized that didn’t fit. It seemed more “systemic”, and the only commonality across these situations was that the prior authorizations were being submitted through CoverMyMeds. When speaking with a CVS Caremark Sr Rep in February, I was told that providers and patients had been expressing the same frustration I just noted. Additionally, you can see more here in the reviews.
(DISCLAIMER: This is an observation based on a pattern of incomplete PAs for the same reasons and the reactions of providers who all indicated the same issue: They never received requests for the information.)
Clinical Absurdity and Medical Impossibility
What do you do when a senior representative at your Pharmacy Benefit Manager (PBM) suggests you ask your provider to give a 30-day prescription for a 90-day quantity of a medication?
I’ve been taking the same dose of a brand-name maintenance medication for over 20 years. Recently, my PBM, CVS Caremark, approved my brand medically necessary PA (2/27/2026) but restricted the system to only dispense a 34-day supply. (This changed to 30-days less than 12 days later.)
What followed was a masterclass in administrative gaslighting:
Excuse 1: First, they told me I just needed my provider to file a ‘maintenance exception’.
Excuse 2: Then, they told my provider that an exception didn’t actually exist. When I called CVS Caremark, a Senior Representative blamed the manufacturer, claiming they restrict the medication to 30 days. I addressed this odd statement as there is nothing on the manufacture’s website or the web indicating the recommendation was accurate*.
The “Solution”: Finally, the Senior Representative spoke with the Prior Authorization team again. Their solution? Have my provider submit a prescription for 180 Celebrex 200 mg capsules to be taken over 30 days.
* Note. That is 6 pills a day of a medication where the FDA safe limit is two. Also, while on hold on that date, I emailed the manufacturer, Viatris, and received the response below:
Screenshots in this image are from: -CareFirst BluePreferred PPO Certificate of Coverage (Plan Sponsor: Government of the District of Columbia) (Obtained via CareFirst) -Responses to medication PA requests from CVS Caremark -Notes from my conversations with representatives at CVS CaremarkI contacted Viatris directly to confirm they had not changed their prescription recommendations.
I was stunned. I pointed out that this sounded like “creative pharmaceutical benefits”—otherwise known as insurance fraud. The representative laughed.
I didn’t know what to say as I got off the phone.
I spoke with my amazing Health Advocate and PCP, and then dug into my hundred-page policy myself.
I found Section 10(a)(4), which explicitly allows a medication like mine to be classified under a “Maintenance Medical Exception” for a 90-day fill. So I’m unsure what rules the senior representative was looking at, but they definitely did not match the rulebook the CVS Caremark Resolutions Specialist saw on 2/27/2026.
Note. CVS Caremark was mentioned as the PBM also responsible in the filing. Because CareFirst writes the “rules” I put them as the primary group in the complaint.
Since that date, I have contacted DC City Council and Mayor Muriel Bowser via email. There are more issues than just the above, but I will explain how I did this in another post.
As of 4/10/2026
After an almost 1-hour call with CVS Caremark on 4/10/2026, a Senior Representative informed me that she could see the maintenance medication exception in my plan documents. At the end of the call, she said that the issue needed to be sent to “account management” and that such issues are often corrected after 5 business days.
I have not heard anything as of 4/18/2026.
The Patient’s Playbook: Protect Yourself
Insurance companies rely on your exhaustion. You must document everything and demand your legal rights.
Track Every Call: Stop scribbling on scrap paper. Use the free Google Form I created—my “Patient’s Log”—to track the date, time, representative name, and action items of every call. Evidence is the only thing that wins appeals.
Check Your EOBs: If you are on a PPO and see a sudden deductible applied to standard pharmacy claims, call your insurer, demand an “Accumulator Adjustment,” and report a “Plan Design Error.”
Never take a verbal denial at face value. You must read the actual rules in your Certificate of Coverage (COC) to catch their lies—just like a Resolutions Specialist pointed out the ‘Maintenance Medical Exception’ in my contract leading me to push a Senior Representative at CareFirst about the frustration I had actually…getting one. (i.e., I couldn’t.)
Patients and Providers: Never take a verbal denial at face value. Demand the policy in writing, contact the manufacturer if they are blamed, and report “creative pharmaceutical benefits” to your state insurance administration immediately
To do this, you must get a copy of your Certificate of Coverage (COC). This is the governing rulebook—usually over 100 pages—not the short “Summary of Benefits.”
Under federal disclosure standards (specifically ERISA), if you submit a written request to your plan administrator for your governing plan documents, they are legally required to provide them to you within 30 days. Failure to comply with this federal disclosure window can carry potential statutory penalties of up to $110 per day.
Stay tuned—because simply obtaining my COC from the DC Government (DCHR) has been an entirely separate battle. I have a copy, but not via DCHR, despite repeated requests.
🗣️ Please share this post and tag @MayorBowser, @CMCHenderson, and the DC City Council Committee on Business and Economic Development. We need proactive DISB market conduct audits, not just individual complaint responses.
Trademarks and Fair Use Notice: All company names, logos, and trademarks—including CareFirst BlueCross BlueShield, CVS Caremark, Viatris, and any brand-name prescription drugs (such as Celebrex)—are the property of their respective owners. Their inclusion in this post and associated images is for educational, informational, and advocacy purposes only and does not imply any affiliation or endorsement.
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.
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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