🟢 Phone Scripts for Caregivers

Exact words to say when you call Medicaid, Medicare, hospitals, insurance companies, and the VA. No more getting stuck, transferred, or told "no."

✓ Free to use ✓ Word-for-word scripts ✓ What to do if they say no

Stopping a hospital discharge you think is too soon

Call this number before midnight on the day of discharge — you have until midnight.

Before you call — have these ready

Your loved one's Medicare number (on the back of their red, white, and blue card)
The hospital's name and address
The name of the doctor ordering the discharge
A copy of the "Important Message from Medicare" form the hospital gave you

Call the BFCC-QIO (your state's Medicare quality reviewer)

Find your state's number at kecc.coaraghealth.com or ask the hospital's patient advocate.

"Hello. My name is [YOUR NAME]. I am calling to file a fast appeal of a hospital discharge for my [mother/father/spouse], [THEIR FULL NAME]. Their Medicare number is [NUMBER]. They are currently a patient at [HOSPITAL NAME]. I believe they are being discharged too soon and I am requesting an expedited review under my rights as a Medicare beneficiary. Please confirm my appeal is filed and give me the reference number."

Important: Once you file by midnight, you cannot be charged for the hospital stay while the appeal is reviewed. You will get a decision the next morning.

If the doctor calls you to discuss the discharge

"I appreciate you calling. I am concerned that [NAME] is not ready to go home safely. Specifically, [describe the concern — for example: 'they still cannot stand without falling' or 'they have not eaten in two days']. Can you document this in their chart and explain why the medical criteria for continued stay are not met?"

If they say no

Your appeal will be denied — they meet discharge criteria.

I understand your opinion. I am still requesting the expedited appeal. That is my right under Medicare. Please give me the QIO reference number.

You need to leave by noon or you will be charged.

I filed an appeal before midnight last night. Under Medicare rules, I cannot be charged while a fast appeal is pending. Please speak with your billing department.

Appealing a Medicare coverage denial

Level 1 Redetermination — you have 120 days from the denial notice to file.

Before you call — have these ready

The Medicare Summary Notice or Explanation of Benefits showing the denial
The claim number from the denial letter
A note from the treating doctor explaining why the care was medically necessary
Your loved one's Medicare number

Call 1-800-MEDICARE (1-800-633-4227)

"Hello. I need to file a Medicare Redetermination appeal for a denied claim. The patient is [FULL NAME], Medicare number [NUMBER]. The claim number is [NUMBER] from my denial notice dated [DATE]. The service denied was [describe]. I believe this denial is wrong because the care was medically necessary. I would like to start the Level 1 appeal process today. Where do I send my written appeal and what supporting documents do you need?"

Your strongest weapon: Get the treating doctor to write a letter that says: "This care was medically necessary because [reason]. The patient required skilled services to maintain or slow decline." Medicare must cover care to maintain function — not just to improve it.

If they say no

The claim was denied because the patient was not improving.

Under the Jimmo v. Sebelius settlement, Medicare must cover skilled care to maintain or slow decline — not just to improve. I would like to appeal based on this ruling.

Calling Medicaid about a waiver or paid caregiver program

How to find out what your state offers and get the process started.

Before you call — have these ready

The care recipient's full name, date of birth, and Social Security number
Their current Medicaid number (if they have one)
Your relationship to them
A brief description of the care they need daily

Call your state Medicaid office or 1-800-677-1116 to find the right number

"Hello. I am calling about Home and Community Based Services waiver programs for my [mother/father/spouse], [NAME]. They are [age] years old and need help with [bathing, dressing, etc.]. I want to find out what programs are available that would allow a family member — specifically me — to be paid as a caregiver. Which waiver programs in [STATE] allow consumer-directed or self-directed care? Is there a waitlist? How do I get them assessed?"

Key words that open doors: Say "self-directed care," "consumer-directed care," or "participant-directed services." These are the programs where family members can be paid. Staff may not volunteer this information unless you ask by name.

If they say there is a waitlist

"I understand there is a waitlist. Can you add [NAME] to it today? What is the estimated wait time? Is there a state plan option — not a waiver — that might cover services sooner? What number do I call to check their position on the waitlist?"

If they say no

Spouses cannot be paid as caregivers.

Can you confirm that for all programs in this state? I have read that some states do allow spousal pay under certain waivers. Can you check if any program in [STATE] allows it?

They do not qualify because their income is too high.

Is there a spend-down option or a Miller Trust that would allow them to qualify? Can I speak with a Medicaid eligibility specialist about planning options?

Fighting an insurance prior authorization denial

Requesting a peer-to-peer review — the most effective tool you have.

Before you call — have these ready

The denial letter with the reference or authorization number
The name of the service or medication that was denied
Your insurance card and policy number
The treating doctor's name and office phone number

Call the insurance company's member services line

"Hello. I received a denial for [SERVICE/MEDICATION] for my [FAMILY MEMBER], policy number [NUMBER]. The authorization number is [NUMBER]. I am calling to request a peer-to-peer review between your medical director and my family member's treating physician, Dr. [NAME], who can be reached at [PHONE]. I want the doctor who denied this claim to speak directly with the treating doctor. How do I arrange that?"

Peer-to-peer reviews work. When treating doctors speak directly with insurance medical directors, denials are overturned 30–70% of the time. Always ask for this before filing a formal appeal.

If peer-to-peer is also denied — filing the formal appeal

"I want to file a formal internal appeal of this denial. What is the deadline to file? Where do I send the appeal and what supporting documents do you need? I will include a letter of medical necessity from Dr. [NAME]. Is there also an external review option if the internal appeal is denied?"

Reporting a concern about a nursing home

Who to call and exactly what to say to get action fast.

Before you call — write down

What you observed and when (date and approximate time)
Names of any staff involved
Any witnesses — other residents or family members
Whether the issue has happened before

Step 1 — Call the nursing home administrator first

"I need to speak with the administrator, please. This is [YOUR NAME]. I am the [son/daughter/spouse] of [RESIDENT NAME] in room [NUMBER]. On [DATE], I observed [describe what happened clearly and calmly]. I am very concerned about the quality of care. I want this documented in writing and I want to know what steps the facility will take to prevent this from happening again. Can you meet with me today?"

Step 2 — If unresolved, call your state Long-Term Care Ombudsman

Find your state Ombudsman at ltcombudsman.org or call 1-800-677-1116

"Hello. I am calling to report a concern about a nursing home resident. My [family member], [NAME], is a resident at [FACILITY NAME AND ADDRESS]. I am concerned about [describe the issue]. I spoke with the administrator on [DATE] and the problem has not been resolved. I would like to file a formal complaint and request an investigation."

Nursing home discharge threats: If the facility says your loved one must leave, say: "I want to formally appeal this discharge. Until the appeal is decided, my family member cannot be forced to leave. That is federal law under the Nursing Home Reform Act. Please contact the Long-Term Care Ombudsman."

Calling the VA about Aid & Attendance or caregiver benefits

Call VA Benefits at 1-800-827-1000 or the VA Caregiver Support Line at 1-855-260-3274

Before you call — have these ready

Veteran's full name and Social Security number
Branch of service and dates of service (month and year)
Character of discharge (Honorable, General, etc.)
Veteran's current income and asset information (approximate)
Name of the condition requiring care

For Aid & Attendance pension — call 1-800-827-1000

"Hello. I am calling about the Aid and Attendance pension benefit for my [father/mother/spouse/veteran], [NAME]. They served in [BRANCH] from [YEAR] to [YEAR]. They are [age] years old and currently need help with [bathing, dressing, meals, etc.]. I want to find out if they qualify for Aid and Attendance and how to apply. Can you walk me through the eligibility requirements and tell me which forms I need?"

Free help applying: Veterans Service Organizations like the American Legion, VFW, and DAV help veterans apply for free. They know the system and can speed up approval significantly. Ask the VA to connect you with a VSO in your area.

For the PCAFC caregiver stipend — call 1-855-260-3274

"Hello. I am calling about the Program of Comprehensive Assistance for Family Caregivers — the PCAFC. I am the [spouse/child/family member] of a veteran, [NAME], who has a service-connected disability rated at 70% or higher. I provide daily care and I want to apply for the caregiver stipend program. Can you tell me how to apply and whether we appear to meet the eligibility requirements?"

Talking to doctors when you have no legal authority yet

What you can say — and how to get a HIPAA release signed quickly.

What you can always do: You can give information to any doctor at any time. HIPAA only restricts what they can tell you — it does not stop you from telling them what you have observed.

Giving information to a doctor (no authorization needed)

"Dr. [NAME], I want to share something I have observed about [PATIENT NAME] that may be relevant to their care. I understand you may not be able to share details with me without authorization, but I can share what I have seen: [describe observations — falls, confusion, not eating, medication errors, etc.]. Please document this in their chart."

Requesting a HIPAA authorization form

"I need a HIPAA authorization form so my [mother/father/spouse] can authorize me to receive their medical information. This is [PATIENT NAME] — I am their [son/daughter/spouse]. Can you print the form right now? We would like to fill it out and have it on file today so I can be involved in their care going forward."

In the exam room — asking the doctor to speak openly

"Doctor, my [parent/spouse] and I are here together, and they have asked me to be part of this conversation. [PATIENT NAME], do you give permission for me to hear what the doctor tells you today? [Patient says yes.] Thank you. Doctor, they are giving verbal permission right now. Please document that in the chart."

If a doctor's office says they cannot speak to you

We cannot share any information without a HIPAA authorization.

I understand. Can I come in today so [NAME] can sign the authorization form? I also want to note that I can share information with you — HIPAA only restricts what you can share with me. Can I tell you what I have observed at home?

These scripts are for general educational purposes only and are not legal advice. Laws vary by state.