Check a prior authorization status by phone with your AI agent

By Jake Marsh Updated Nov 12, 2026 2 min read

Short answer: Tell your agent the plan, the member ID, the procedure or medication and the ordering doctor. CallForMe calls the member services number on your card, waits on hold, and asks whether the request was received, approved or denied, what's missing and the reference number. Plans usually verify the member first, so it patches you in with transfer_to for that part.

“Call Lakeside Health Plan member services about the prior authorization for my knee MRI that Dr. Patel's office sent last week. Find out if they got it, whether it's approved, and the reference number. If they need to verify me, patch me in at 214-555-0147.”

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Prior authorization calls are mostly waiting: a menu, a hold, a member ID, and "it's still pending review." Your agent can do that part, come back with the status and a reference number, and bring you in only when the plan needs to hear from you.

What your agent does

find_business finds the number if you don't have it, but the member services number on the back of your card reaches the right plan and department.
plan_call drafts the opening and checklist and flags what the rep will likely ask that you haven't given (member ID, the ordering doctor, the date of service).
place_call dials with the member ID, the procedure or medication and the doctor's name in details, and your number in transfer_to:

What your agent sends (for developers)

{
  "phone": "+18005550123",
  "business_name": "Lakeside Health Plan",
  "goal": "Find out whether the prior authorization for a knee MRI requested by Dr. Patel was received, its status, and the reference number. If they need to verify the member, connect Jordan.",
  "details": "Member: Jordan Reyes. Member ID LHP-55120934. Procedure: MRI of the right knee. Ordering doctor: Dr. Anita Patel, Northside Orthopedics. Sent by the doctor's office around Nov 4.",
  "questions": ["Was the request received, and when?", "Is it approved, denied or pending?", "If pending, is anything missing and when is a decision due?", "What is the reference or authorization number?"],
  "on_behalf_of": "Jordan Reyes",
  "transfer_to": "+12145550147",
  "constraints": "Don't share anything not listed in details. Don't agree to change the procedure or the provider."
}

get_call runs with wait_seconds: 45 until the call ends. If the rep asks something new ("what's the date of service?"), it arrives as pending_question and your agent answers with answer_question or asks you.

Example result

Illustrative example: names, numbers and dates are made up.

Question	Answer
Received?	Yes, on Nov 5 from Northside Orthopedics
Status	Pending clinical review
Missing	Notes from the last office visit
Reference number	PA-2026-118842

outcome.next_steps: "Ask Dr. Patel's office to send the last visit notes to the fax number on the request. A standard decision is due within 7 calendar days of a complete request."

Tips

Put the member ID, the procedure or medication, and the ordering doctor in details. Those are what the rep asks first.
Set transfer_to on every health plan call. Verification is the norm, and being patched in beats calling back.
If the plan says the request never arrived, have your agent call the doctor's office next with the plan's fax number and the reference number you got. Two short calls usually settle it.
Ask for the reference number every time, even when the answer is "pending". It's what the next person will ask for.
For a denial, have the assistant ask for the specific reason and the appeal deadline.

What it costs

A typical status call with a 12 minute hold and a 3 minute conversation runs about 15 minutes after the answer: $1 plus 13 minutes at $0.40, so $6.20. Nothing if the line is busy or nobody picks up.

Sources

CMS fact sheet: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F): 72 hours for expedited and 7 calendar days for standard requests, specific denial reasons, compliance starting January 1, 2026, drugs not covered, QHP issuers on the federal exchanges excluded from the timeframes.

Questions

How long does a health plan have to decide a prior authorization?

Since January 1, 2026, Medicare Advantage plans, Medicaid and CHIP must decide urgent (expedited) requests within 72 hours and standard requests within 7 calendar days, under CMS's Interoperability and Prior Authorization Final Rule (CMS-0057-F). It doesn't cover drug prior authorizations, and marketplace plans on the federal exchange are excluded from these deadlines. Other plans follow their own and state rules.

Will the plan talk to an AI assistant about my authorization?

Many reps will confirm whether a request was received once they have the member ID. Most need to verify the member before giving details. When they do, the assistant patches you in with transfer_to so you verify yourself, and it stays out of it from there.

Should it call the insurer or the doctor's office?

The doctor's office usually submits the request and hears the decision first, so call them to find out whether and when it was sent. Call the plan's member services number (on your card) to find out whether it arrived and where it stands. If the two don't match, your agent can call both, one after the other.

What if the authorization was denied?

Ask for the specific reason and how to appeal. For the plans the CMS rule covers, a specific reason for a denial is required. The assistant records it, and your agent can plan the next call, usually to the doctor's office about a peer-to-peer review or an appeal.

Will it give my Social Security number or date of birth?

It never gives SSNs, card numbers or passwords. It shares only what you put in details. Leave your date of birth out and let the plan verify you directly when you're patched in.

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