모든 템플릿

Prior Authorization Patient Experience Survey

Measures patients' experiences with insurance prior authorization, capturing process clarity, wait times, care impacts, and pain points to identify systemic improvement opportunities.

샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 22개 · 약 10분
Q01
메시지

Welcome to the Prior Authorization Experience Survey. This survey asks about your experience with insurance prior authorization (pre-approval) for medical care or medications. It should take approximately 7–10 minutes to complete. Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers—we are interested in your honest opinions and experiences. All responses are confidential and will be reported only in aggregate. Please click 'Next' to begin.

Q02
객관식

Have you ever needed prior authorization (pre-approval from your health insurance) for medical care or medication?

  • Yes, within the last 3 months
  • Yes, 3–12 months ago
  • Yes, more than 12 months ago
  • No, I have never needed prior authorization
  • Not sure
Q03
객관식

Who primarily handled your most recent prior authorization request?

  • Doctor or clinic staff
  • Me (the patient)
  • A family member or caregiver
  • Health insurance plan
  • Pharmacy
  • Don't know
Q04
객관식

Approximately how long did it take from when the prior authorization was submitted to when a decision was made?

  • Same day (no delay)
  • 1–3 days
  • 4–14 days
  • 15–30 days
  • Over 30 days
  • Still pending
  • Don't know
Q05
의견 척도

To what extent did the prior authorization process delay your care or treatment?

척도: 17
최소:Not at all최대:To a great extent
Q06
순위 매기기

Rank the following aspects of prior authorization from most frustrating (top) to least frustrating (bottom).

  1. Not knowing the status of the request
  2. Having to repeat information or submit forms multiple times
  3. Long phone wait times
  4. Conflicting information between insurer and provider
  5. Last-minute denials or changes
  6. Difficulty reaching the right person
드래그하여 순위 지정
Q07
장문형

If you could change one thing about the prior authorization process, what would it be?

Q08
객관식

What type of health insurance do you currently have?

  • Employer-provided insurance
  • Individual/marketplace plan (ACA)
  • Medicare
  • Medicaid
  • Military/VA (TRICARE, VA)
  • Uninsured
  • Other
  • Prefer not to say
Q09
메시지

Thank you for completing this survey. Your responses are confidential and will be used to help identify ways to improve the prior authorization experience for patients. If you have questions about this research, please contact the study team at the email provided in your invitation.

Q10
객관식

Which types of services or treatments required prior authorization? Select all that apply.

  • Prescription medication
  • Imaging (e.g., MRI, CT scan)
  • Specialist visit or referral
  • Surgery or procedure
  • Durable medical equipment
  • Lab tests
  • Mental health or behavioral health services
  • Physical therapy or rehabilitation
  • Other (please specify)
Q11
객관식

Which communication channels were used during your most recent prior authorization process? Select all that apply.

  • Phone calls
  • Patient portal messages
  • Paper forms
  • Fax
  • In person at the clinic
  • Email
  • Insurer website or app
  • Pharmacy system or app
  • Other (please specify)
Q12
객관식

Approximately how many total hours did you (or a caregiver) spend on your most recent prior authorization (e.g., phone calls, paperwork, follow-ups)?

  • Less than 1 hour
  • 1–3 hours
  • 4–6 hours
  • 7–10 hours
  • More than 10 hours
  • Don't know
Q13
의견 척도

To what extent did the prior authorization process cause you emotional stress or anxiety?

척도: 17
최소:Not at all최대:To a great extent
Q14
객관식

Which of the following, if any, were helpful during your prior authorization process? Select all that apply.

  • Clear instructions from my provider
  • A staff member handled the process for me
  • Automatic status updates (text, email, or portal)
  • Support with filing an appeal
  • Financial assistance or copay card
  • A dedicated phone line or team for prior authorization
  • None of these
Q15
AI 인터뷰

Based on your survey responses, we'd like to understand more about your prior authorization experience. What was the single most challenging part of the process for you?

Q16
드롭다운

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65+
  • Prefer not to say
Q17
객관식

What was the outcome of your most recent prior authorization request?

  • Approved without changes
  • Approved with an alternative (e.g., different drug or test)
  • Approved after appeal
  • Denied
  • Still pending
  • Don't know / Not sure
Q18
의견 척도

To what extent did the prior authorization process create a financial burden for you (e.g., unexpected costs, lost wages)?

척도: 17
최소:Not at all최대:To a great extent
Q19
객관식

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Another gender identity
  • Prefer not to say
Q20
의견 척도

Overall, how clear was the prior authorization process (what was required of you and what steps to follow)?

척도: 17
최소:Very unclear최대:Very clear
Q21
의견 척도

To what extent did the prior authorization process disrupt your daily activities or responsibilities?

척도: 17
최소:Not at all최대:To a great extent
Q22
드롭다운

What is the highest level of education you have completed?

  • Less than high school
  • High school or equivalent
  • Some college or trade school
  • Associate degree
  • Bachelor's degree
  • Postgraduate or professional degree
  • Prefer not to say

포함된 기능

  • AI 후속 질문

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다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • Includes structured questions on process clarity, wait times, communication channels, and outcomes, followed by an AI follow-up interview that adaptively probes each patient's specific prior authorization experience for deeper qualitative insight
  • Captures multi-dimensional care impact through dedicated opinion-scale questions on delay, emotional stress, financial burden, and disruption to daily activities, plus a ranking question to prioritize the most frustrating aspects
  • Uses an open-text question to surface unprompted improvement ideas, which the AI follow-up interview can then explore further with tailored probing questions
  • Collects demographic and insurance-type context (insurance type, age, gender, education) to enable segmentation of systemic pain points across patient groups

Jotform

Medicare Prior Authorization Form Template

This is an administrative submission form for requesting Medicare prior authorization, not a patient experience survey — it's built for providers/staff to submit authorization requests rather than to measure how patients experienced the process. It is a fielding-ready form, but for a different use case than experience research.

잘하는 점

  • Ready-to-use, fillable form structure for prior authorization submissions
  • Familiar drag-and-drop form builder from an established forms platform
  • Likely supports file uploads/signatures typical of clinical paperwork

아쉬운 점

  • Not designed to capture patient sentiment, wait-time perception, or care impact — it's a request form, not an experience survey
  • No adaptive AI interview or follow-up probing to explore why a patient found the process difficult
  • No built-in per-response quality scoring or automated experience reporting

Typeform

Prior Authorization Form Template

Typeform's template is also framed as a prior authorization request/submission form rather than a survey measuring patient-reported experience with the process. It offers Typeform's conversational form UI but is not structured around clarity, delays, emotional or financial burden, or systemic pain points.

잘하는 점

  • Clean, conversational one-question-at-a-time interface
  • Easy to customize branding and question flow
  • Mobile-friendly form completion experience

아쉬운 점

  • Static question set with no adaptive AI follow-up to dig into individual patient pain points
  • Appears oriented toward form submission/intake, not experience measurement (no wait-time, stress, or financial-burden scales evident)
  • No transparent prompt methodology or automated qualitative reporting

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