billradar
Call cheat sheet

Before you call Sample Health Plan

1

Say this first

“Hi, I'm calling about CLM-7765301 (denied with code P31) for Maria Sample. I want to understand the denial and appeal it.”

2

Have these numbers ready

Member ID (Sample Health Plan)SHP-000-4417
Claim numberCLM-7765301
3

If they say

“The stay needed prior authorization.”
My plan document says (page 2): “Prior authorization is not required for a hospital stay for childbirth of up to 48 hours after a vaginal delivery or 96 hours after a cesarean section.”Plan document p.2
“Without prior authorization we can't pay it.”
My plan document says (page 2): “In emergency situations or when prior authorization cannot be obtained, covered services will not be denied solely for lack of prior authorization.”Plan document p.2
“It's too late to appeal.”
I can appeal until April 13, 2027. My plan document says (page 4): “You may file an appeal within 180 days after you receive notice of a denial.”Plan document p.4
“You have to send that in writing.”
I will. Your plan document gives the address (page 4): “Send your appeal in writing to: Appeals Department, Sample Health Plan, PO Box 12345, Riverton, ST 12345.”Plan document p.4
“We can't share the claim file.”
My plan document says (page 4): “You may ask for free copies of all documents, records and other information relevant to your claim.”Plan document p.4
4

Ask for

  • The name of the person you speak with
  • A reference number for the call
  • What happens next, and by when, in writing
  • Ask them to note on the claim that you are appealing

💡 Be polite, take notes, and confirm the next steps before you end the call.