How to call your insurance plan

A 15-minute call, prepared, will get you further than an hour of frustration. Here is exactly what to bring.

Have these ready

Member ID, the CPT code(s), the diagnosis code if you have it, the date of service, the provider's name and NPI if possible, and a pen — write down everything.

What to ask

1) Is this CPT code subject to prior authorization on my plan? 2) Is the provider in-network for my plan and for this service? 3) What is my expected cost-share — copay, deductible status, coinsurance? 4) Is there a less-expensive in-network alternative facility? 5) Can you email or mail me the policy criteria for this service?

Always capture

The representative's name, the date and time of the call, and a reference number for the call. If they make a promise (like a benefit quote), ask them to document it in your file.

If you get stuck

Ask to escalate to a supervisor. Ask whether there is a member advocate or care management team. Many states also have an insurance ombudsman that can help.

Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.