Tag: claims processing

Don’t Lose Track of Health Insurance Calls: A free tool for patients and families

Written by Stephanie M. Nixon, PhD, CCC-SLP on February 20, 2026. Posted in Health care, Health Insurance, Navigating health care. No Comments on Don’t Lose Track of Health Insurance Calls: A free tool for patients and families

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.

Make the fillable form an app on your phone

Star the backstage form in Google Drive so you can review responses during calls.

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.

You can see all responses as well by clicking responses at the top.

📄 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.

Health insurance claim denials and downcodes: What can I do?

Written by Stephanie M. Nixon, PhD, CCC-SLP on December 23, 2024. Posted in Health Insurance, Uncategorized. No Comments on Health insurance claim denials and downcodes: What can I do?

Note. I’m writing this mostly from a patient perspective, but it can be used by practitioners to understand the process and empower patients.

What is a health insurance denial?

A denial is when the health insurance refuses to pay for a medical service or treatment that has been provided or requested.

Some reasons health insurance processors give for claim denials:

A service isn’t covered by the plan
A service is said to be “not medically necessary”
A plan only covers “in-network” providers
Maximum plan coverage has been reached
Filing error
Coding or billing error

Prior authorization for a medical service (e.g., speech-language evaluation, MRI, etc.) is different than a medical claim.

A medical claim is a bill that your provider sends to your health insurer for your medical care (or if “out-of-network”, a claim you send to your health insurer). (This claim includes codes called CPT codes – or procedure codes – associated with the costs.)
A prior authorization (also called precertification) is when your health plan requires patients to get approval for a medical service or medication before they receive the care. Information from your chart must be submitted from your chart by your practitioner (and sometimes by you). (I will address PAs more in a later post.)

When I refer to denial in this post, it means denial of a code on a medical bill or denial of a prior authorization request.

But remember there is a difference. And you can sometimes prevent medical claim denial by confirming whether precertification or prior authorization is needed for a medical service.

For a medical claim, the medical service was already completed and the bill was filed with insurance. You could be stuck with the balance when there is a denial.

For a prior authorization, the provider is requesting that your health insurance company agree to pay for a medical service. The service has not been completed.

Note. As an SLP, a frequent reason that I saw claim denials and prior authorization denials by private health insurance companies for a child’s speech-language therapy services was the plan did not include “habilitative” services OR only included them for autism spectrum disorder. i.e., “This service is only covered in cases of accident, injury, stroke, or autism spectrum disorder”.

What I do. I often call to confirm coverage of any services I am going to receive (or when I was providing services to patients. I ask these questions: Are there any exclusions? Do I need prior authorization? If the answer is yes to either or both, I ask for additional information about these. I take notes. I write down the date, time, and name of the person on the phone. I put that information where I won’t lose it. (Take a picture, put it in the notes app on your phone, anything.)

What is downcoding during claims processing?

The health insurance company changes a higher-level CPT (i.e., procedure) code (e.g., CPT 99214 indicating moderate complexity over 30 minutes) to a lower-level CPT code (e.g., 99213 indicating low complexity 20 minutes).

No matter in- or out-of-network it results in lower reimbursement as the lower code is associated with a lower payment amount.

An example from one of my out-of-network claims where my health insurance company used downcoding for a CPT code.

Column A = Billed Amount
Column B = Member Rate (nothing there because this is out-of-network)
Column C = Not payable by plan
Column D = Applied to deductible (I hit my out-of-network deductible early this year.)
Column E = My copay (does not apply to out-of-network)
Column F = Remaining amount (Amount billed – Notpayable)
Column G = Plan’s share (For me, this was 75% of the amount they deemed appropriate after downcoding)
Column H = My coinsurance (For me, this was 25% of the amount they deemed appropriate after downcoding)
Column I = My total share (Coinsurance + Not payable by plan)

You (and your practitioner if they are in-network) must watch your explanation of benefits for downcoding. This isn’t something they will tell you with a phone call or an email. It appears with those numbers referencing the reason which is at the bottom of the bill.

So if you see those numbers, look for a reason. If you are struggling to read the explanation of benefits, then ask a biller at your hospital, the specialist, or you could even email me.

Health insurance companies will say they do this to prevent upcoding by practitioners (which is fraud).

What do I do now?

Review the denial notification (These are not easy to understand for anyone – even some doctors can’t read an Explanation of Benefits. Ask for help from your provider, insurance company, a friend, me, anyone, if it’s confusing)
Contact your provider
Contact your insurance company.
- Ask them why
- Ask what can be done to correct the claim
- Sometimes it is a simple processing error. (Once my annual woman’s exam was processed by my health insurance as if my husband was the patient, despite this clearly being inaccurate. It was reprocessed correctly without an appeal)
- Other times the doctor didn’t provide enough information, or the insurance company needs to see case notes.
Gather the documents you need (medical records, test results, practitioner notes)
File the internal appeal: This information is on the explanation of benefits, and sometimes you can do this through your health insurance online portal.
- If you need to fax the appeal, then keep a copy of the sent receipt. (I use e-fax.)
- If you need to snail mail the appeal, then note the date and time you sent it or even send it certified mail return receipt. (I say this after having my private insurance claiming they did not receive documents multiple times.)
Learn about the appeal process:
- DEADLINES are important (set calendar reminders, whatever you need to follow-up on these)
- Know what to do next if the appeal is denied: Sometimes you file an external appeal, sometimes you have another level of internal appeal
If you are struggling with the process, then contact your State’s Insurance Department (often there is a regulatory body like an insurance bureau and a group that helps navigate appeals)

Only some people file appeals – know your rights.

Gupta, Collins, Roy, and Masitha (2024) used information from a survey by SSRS that included work-aged insured US adults from April 18 through July 31, 2023 to look at insurance denials and appeals. Of the adults they reviewed, 45% of insured working-aged adults were charged for a medical bill or copay for services they though should be covered by health insurance. They noted the following in a Commonwealth Fund publication

Less than half of the 45% who reported the errors challenged the errors. Why? The most reported reason said they didn’t know they had the right to challenge a medical bill.
About 2 of 5 who challenged (i.e., appealed) their bill, reported it was reduced or eliminated by the insurance company.
17% reported that their insurer denied coverage for care recommended by their doctor; more than half said neither they nor their doctor challenged the denial
About 6 of 10 adults who experienced a coverage denial also experienced delayed care

There are many issues cited in this report including how complexity of US health insurance has affected patients. These patients may struggle to understand what is and what isn’t covered and their financial liabilities.

Personally, even selecting a health plan each year is complicated by terms like the following:

HMO
PPO (but some of these are really HMOs pretending to be PPOs)
POS (point of service)
In-network deductible
Out-of-network deductible
In-network max out of pocket
Out-of-network max out of pocket
Wait! There’s more! Then you have 105% of the maximum allowed medicare rate for out-of-network
Then how much of the out-of-network bills go toward your deductibles? Does all that go toward the max out of pocket out-of-network? (You’d be surprised.)
Does the coverage change based on the service? (Yes.)
Do they change coverage based on the service provider? (i.e., facility vs. clinic)
Are there a maximum visits?
With my insurance cover allied health services (i.e., speech-language pathology, physical therapy, and occupational therapy)? How many visits per year? Are these capped individually or across services? Copay? Are there exclusions?

The list goes on…

What can I do if I lose the appeal at all the levels available?

If your plan is through your (or your spouse’s) employer: Explain the issue to HR at your company. There might be something in what they negotiated that could change the situation, or they could negotiated better benefits for the next plan year. Some employers even have support available for employees in these instances.

Advocate. You could also contact your State and Federal representatives to express your frustration regarding the situation and request a change to requirements for healthcare insurance that would prevent this from happening. This won’t take care of the current claim, but it might lead to change in the future.

Here are two TikToks from my personal experience navigating claims with my private insurer.

@omymanycats
Health insurance denials and claim mishandling are something I have experienced for years. These are merely a few. I wanted to get this out for the ABC News report that Dr. Glaucomflecken mentioned but it seems the account is gone.#healthinsurance #healthinsurancedenials #chronicillness #navigatinginsurance @Dr. Erin Nance 🇺🇸 @Dr. Rubin, MD @Dr. Glaucomflecken @ABC World News Tonight @Aaron Parnas @UnderTheDeskNews
♬ original sound – omymanycats

@omymanycats
It seems unethical for a claims processor who was not present during my medical appointment to recode CPT codes on my bills. It seems more egregious when I need to monitor them closely to ensure they reprocess the bill correctly up on me winning an appeal. And even moreso when they continue to do so after I’m told it was just human error. #healthinsurance #healthinsurancestruggles #appeal #claimprocessingerrors #chronicillness #chronicillnesstiktok #ishealthinsurancereallytheretohelp #spoonies
♬ original sound – omymanycats – omymanycats

Disclaimer. This article is based on research and personal experience. This information is not intended as legal advice or healthcare advice. This is informational and parts not from research or able to be documented in my EOBs/experience with my personal private insurance would be based on my personal opinion.

Health Insurance, Uncategorized

appealing, claims processing, downcoding, health insurance, health insurance appeals, healthcare

Health insurance: Disparities in Billing and Claims Processing

Written by Stephanie M. Nixon, PhD, CCC-SLP on December 22, 2024. Posted in Health Insurance. No Comments on Health insurance: Disparities in Billing and Claims Processing

What is disparity? “A noticeable and usually significant difference or dissimilarity”. Think income, education, race, and ethnicity.

Individuals with disabilities (including chronic health conditions, chronic diseases) are another group that might experience health disparity, but there is less research on this group. Krahn, Walker, and Correa-De-Araujo (2014) discuss the history and definitions of disability.

Disparities across income, education, race, and ethnicity

Hoagland, Yu, and Horny (2024) examined the association between patient demographics and insurance denials for preventive care among a cohort of 1,535,181 privately insured patients seeking preventive care in the US.

What preventive care was considered in this study? Contraceptive administration, breast cancer screening, cholesterol screening, colorectal cancer screening, depression screening, diabetes screening, and wellness visits.

Here is a summary of their findings:

Patients with low incomes (<$30,000 yearly), high school degree or less, and from minoritized racial and ethnic groups experienced higher rates of claim denials. Most frequently these were noncovered service-diagnosis code pairs and billing errors. (What does this mean? People’s access to basic preventive care is different based on their demographic – or income, education, racial, and ethnic background. This is considered inequity)
- Income: The lowest income group (<$30,000 yearly) had 43% higher odds of any denial than those in the highest income group (benefit denials and billing errors; statistically significant).
- Race and Ethnicity:
  - Non-Hispanic black patients had 19% higher odds of denials compared with non-Hispanic white patients
  - Hispanic patients had 16% higher odds of denials compared with non-Hispanic white patients
  - Asian patients had 54% higher odds of denials compared with non-Hispanic white patients
- Education: Differences were not statistically significant
Did practitioners resubmit bills (i.e., file the bill again) after denials?
- 32.4% of practitioners resubmitted the claims.
- What amount was unpaid by health insurance? The mean (average) of the unpaid denied claim was $1395. This was left to patients 92.85% of the time and varied by patient income, race, and ethnicity.
  - Low-income patients had a higher burden than high-income patients (medians of $412 vs. $365, respectively)
  - Non-Hispanic black (median $390), Hispanic (median $464), and Asian (median $522) patients each facing higher costs than non-Hispanic White patients (median $357)
  - Smaller differences between less-educated patients (median $384) compared with those who had more education (median $399)

Financial burden for those with disabilities, chronic illness, and chronic disease

Note. I struggled to find research addressing this topic as a disparity, and I know I am not including everything out there. Please share any additional information in the comments or email me.

Below is a summary of what I found.

Increased chronic health conditions = increased financial burden. The more chronic conditions a person has is associated with an increased financial burden (i.e., increased debt, increased medical debt in collections, and increased out-of-pocket medical costs; Becker, Scott, Moniz, Carlton, & Ayanian, 2022)
Medical debt = worse population health. Medical debt is associated with worse population health (i.e., more days of poor physical and mental health, loss of years of life, higher mortality rates for all; Han, Hu, & Zheng, 2024)
If you use health services more, then you’re more likely have a claim denied (Pollitz, Pestaina, Lopes, Wallace, & Lo, 2023)
- Of the “high utilizers” (those with more than 10 provider visits in a year), 27% experienced a denied claim
- Of the “moderate utilizers” (3-10 visits in a year), 21% experienced a denied claim
- Of patients with less than 3 provider visits in a year, only 14% experienced a denied claim
Consequences of patients whose problems included denied claims (Pollitz, Pestaina, Lopes, Wallace, & Lo, 2023)
- Delays receiving care/treatment (26% for those denied and 13% for those who were not)
- Unable to receive medical care or treatment recommended by the medical provider (24% for those denied and 13% for those who were not)
- Declined health (24% for those denied and 10% for those who were not)
- Paid more for treatment or services than they expected to pay (55% for those denied and 16% for those who were not)
Pollitz, Pestaina, Lopes, Wallace, & Lo (2023) also noted the following about consumers with denied claims:
- Most patients did not know they had appeal rights
- Most (85%) do not file formal appeals (appeal rights vary based on coverage as do the rules; the process can be complicated)
- Often those who need to appeal the health insurance decisions use a lot of health services, and may be too sick to advocate for themselves. (There are programs, Consumer Assistance Programs, available to help; however, they don’t exist in all states and Congress hasn’t appropriated funds since 2010.)

Han, Hu, Zheng, Shi, and Yabroff (2024) noted that policies increasing access to affordable health care could improve population health.

Keep in mind that most of this information describes associations between chronic conditions, medical visits, and financial burden. This means that the values of the variables (e.g., chronic health conditions and financial burden) provide information about each other. This doesn’t mean that more chronic health conditions causes more financial burden, BUT it does mean we can predict the financial burden more accurately when we know the number of chronic health conditions a person experiences.

But implementing such policies will take time and working with both State and Federal elected officials.

What can you do in the in the meantime?

Monitor your medical bills
Know your rights
Ask questions
If you don’t understand something your provider puts on a bill OR your insurance company has on the “Explanation of Benefits”, then ask. (You can even ask me)

But please don’t ignore the error. And I understand how exhausting this is. It isn’t easy. It’s frustrating. It is disheartening. It’s overwhelming.

Disclaimer. This post is not medical or legal advice. It is informational in nature with some information regarding the author’s opinion.