Measures patients' experiences with insurance prior authorization, capturing process clarity, wait times, care impacts, and pain points to identify systemic improvement opportunities.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Template Overview
22
Questions
AI-Powered
Smart Analysis
Ready-to-Use
Launch in Minutes
This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.
Sample Survey Items
Q1
Chat Message
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.
Q2
Multiple Choice
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
Q3
Multiple Choice
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)
Q4
Multiple Choice
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
Q5
Multiple Choice
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)
Q6
Multiple Choice
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
Q7
Opinion Scale
Overall, how clear was the prior authorization process (what was required of you and what steps to follow)?
Range: 1 – 7
Min: Very unclearMid: NeutralMax: Very clear
Q8
Multiple Choice
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
Q9
Multiple Choice
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
Q10
Opinion Scale
To what extent did the prior authorization process delay your care or treatment?
Range: 1 – 7
Min: Not at allMid: NeutralMax: To a great extent
Q11
Opinion Scale
To what extent did the prior authorization process cause you emotional stress or anxiety?
Range: 1 – 7
Min: Not at allMid: NeutralMax: To a great extent
Q12
Opinion Scale
To what extent did the prior authorization process create a financial burden for you (e.g., unexpected costs, lost wages)?
Range: 1 – 7
Min: Not at allMid: NeutralMax: To a great extent
Q13
Opinion Scale
To what extent did the prior authorization process disrupt your daily activities or responsibilities?
Range: 1 – 7
Min: Not at allMid: NeutralMax: To a great extent
Q14
Ranking
Rank the following aspects of prior authorization from most frustrating (top) to least frustrating (bottom).
Drag to order (top = most important)
Not knowing the status of the request
Having to repeat information or submit forms multiple times
Long phone wait times
Conflicting information between insurer and provider
Last-minute denials or changes
Difficulty reaching the right person
Q15
Multiple Choice
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
Q16
Long Text
If you could change one thing about the prior authorization process, what would it be?
Max chars
Q17
AI Interview
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?
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 6
Q18
Multiple Choice
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
Q19
Dropdown
What is your age?
18–24
25–34
35–44
45–54
55–64
65+
Prefer not to say
Q20
Multiple Choice
How do you describe your gender?
Woman
Man
Non-binary
Another gender identity
Prefer not to say
Q21
Dropdown
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
Q22
Chat Message
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.
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