Peer review on first submission?

[flmama 105]

I'm sorry for all of the questions lately...

So, my file was submitted to insurance on Monday. They verbally told my coordinator that I would be denied because I didn't have a 6 month diet (after telling her in January that I only had to have "tried and failed" to diet in the past...nothing about the 6 month diet).

I called today to ask a question about the 6 month diet and the nurse told me that my file is in physician peer-to-peer review.

I thought peer reviews were just for appeals after you have been denied? Did anyone else have a peer review with their first submission?

I'm hoping that this is a good sign and there is a chance they will approve without the 6 month diet, since they gave incorrect information to my coordinator. Trying not to get my hopes up though.

[flmama 105]

A nurse called me today to update me and let me know that the peer review sshould be completed next week.

Apparently if any info is missing or its not a clear "yes " they automatically do a peer to peer review. So it is possible that they could determine its medically necessary without me doing the 6 month diet. So here is hoping.

[Kristina J. 581]

Keeping my fingers crossed for you!!!!!!!!!!!