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.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
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
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
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
To what extent did the prior authorization process delay your care or treatment?
Rank the following aspects of prior authorization from most frustrating (top) to least frustrating (bottom).
- 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
If you could change one thing about the prior authorization process, what would it be?
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
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.
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)
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
- Insurer website or app
- Pharmacy system or app
- Other (please specify)
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
To what extent did the prior authorization process cause you emotional stress or anxiety?
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
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?
What is your age?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65+
- Prefer not to say
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
To what extent did the prior authorization process create a financial burden for you (e.g., unexpected costs, lost wages)?
How do you describe your gender?
- Woman
- Man
- Non-binary
- Another gender identity
- Prefer not to say
Overall, how clear was the prior authorization process (what was required of you and what steps to follow)?
To what extent did the prior authorization process disrupt your daily activities or responsibilities?
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
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- 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 TemplateThis 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.
What it does well
- 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
Where it falls short
- 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 TemplateTypeform'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.
What it does well
- Clean, conversational one-question-at-a-time interface
- Easy to customize branding and question flow
- Mobile-friendly form completion experience
Where it falls short
- 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
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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