When to build this
None of its own, and that is the trap. Build this BEFORE you file, because it is the exhibit your request rests on and adding it later means filing twice.
What to do
Get the plan's own list first
Ask which in-network providers the plan says can perform your specific procedure, by name. Then you are checking THEIR list rather than assembling your own, which puts the burden where it belongs.
Fill a row while you are still on the call
Not afterwards. The name of the person who answered is the column people skip and the one that does the most work: it turns the office said into something a reviewer can check.
Record which kind of no you got
Does not perform it at all. Performs it but cannot schedule you in a usable window. Performs it but requires something you cannot complete. Three different arguments, and reviewers treat them differently.
Follow up by email where you can
One line: confirming our call today, you told me X. Their answer in their own words is worth more than your note of it, and a non-reply to an accurate summary is useful too.
Attach it as a table, not as prose
One row per provider, the plan's own list beside it, a short covering paragraph above. Do not bury it in a paragraph — a reviewer scanning for the count should find it in seconds.
The grid
Six columns. Print this page, or rule the same six on paper, or copy them into a spreadsheet — the format matters far less than filling it in during the call.
- PROVIDER — practice name, and the surgeon's name if you have it.
- DATE AND TIME — the day you called and roughly when. Both, because a reviewer reads a timestamped log differently from a dated one.
- NUMBER CALLED — the one you actually dialled, which may not be the one in the directory.
- WHO ANSWERED — first name and role is enough. This is the column that makes the row checkable.
- WHAT THEY SAID — their words, not your summary. Wait times, prerequisites, whether they perform it at all.
- WHICH KIND OF NO — does not perform it · cannot schedule in time · prerequisite you cannot meet · or a yes, with the date they offered.
Both stay on your device. Neither one sends anything to this site.
A worked row, so the shape is obvious
Riverside Plastic Surgery · 12 March, about 10:15am · (555) 0100, from the plan directory · spoke to Dana, scheduling · said the practice does not perform this procedure and has not for two years, suggested calling the university hospital · DOES NOT PERFORM IT.
That is one row and it took the length of the call. Five of those is a network-adequacy argument.
What it is for, in one line
A plan tells you its network is adequate. This is the document that answers with names, dates and what their own listed providers actually said. It is the single most persuasive thing most readers can produce without a lawyer, and it costs an afternoon of phone calls.
Common questions
- Does a log I wrote myself count as evidence?
- Yes, if it is contemporaneous and specific. A dated log naming the person you spoke to and quoting their answer is ordinary evidence in an appeal file. Where you can, follow up by email so their answer exists in their own words too.
- What if a provider will not confirm anything in writing?
- Most will not, and that is normal. Note that they declined, in the row. A refusal to confirm in writing is itself a fact about how reachable that provider is.
- How many providers do I need to call?
- Every one the plan named, and then any others you find. The point is not a threshold number; it is that you checked their whole list and can show what each one said.
Where to go next
Sources for the legal points on this page
Also on this page, without a citation yet
- That any plan or reviewer must accept your log. Nothing obliges them to. What makes a contemporaneous, specific log persuasive is that it is checkable and visibly written the same day — not a rule requiring anyone to credit it.
These are specific and checkable and we have not yet checked them against a primary source. Treat them as a starting point rather than as settled, and do not put them in an appeal without confirming them.