CareFinder patient resource

Insurance verification call log

Use one sheet for one planned, non-emergency service. This log helps you ask precise questions and preserve the answers; it does not guarantee coverage or payment.

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Privacy: Record only what you need. Use the last four digits—not the full member or claim number—and keep the completed sheet private. Do not email this worksheet to CareFinder.

1. Call and plan

Date Time and time zone Health plan / insurer Plan type, if known Member-services number called Member ID — last 4 only Representative / department Call reference number

2. Exact planned service

Clinician or facility Street location Service, test, or visit being discussed Planned date, if known Ordering / referring clinician, if relevant

3. Questions asked

Is this exact clinician or facility currently in-network for this plan? Does network status differ by location, clinician, or service? Is a referral required? Who submits it? Is prior authorization required? For which part? What deductible, copay, or coinsurance may apply? Are laboratory, imaging, or professional bills handled separately? Is written plan information available for this answer? What should I do if the facility gives different information?

Insurer’s answer and plan document cited Facility’s separate confirmation, including who confirmed it

4. Next action

Person / department responsible Deadline or follow-up date Document, referral, authorization, or call still needed

Remember: A phone answer, directory result, or reference number can help document a call, but the plan and processed claim determine benefits. Reconfirm time-sensitive details before non-emergency care.