Peer To Peer Review

[0tracy0 6]

Hi everybody. Has anyone had to do a peer to peer review? If so, how long did it take to get an answer?

[audreae 7]

Hi everybody. Has anyone had to do a peer to peer review? If so' date=' how long did it take to get an answer?[/quote']

I have the same question. I just found out today that has to take place. I know that a peer to peer is when the doctor from your insurance must speak with usually both the primary doctor and surgeon to make a decision if the insurance will approve the surgery. This usually happens when the insurance didn't receive enough info to make the decision solely based on info submitted by the surgeon. I just don't know how long it takes but I guess they have a certain amount of time to either submit more info or call the doctor from the insurance.

[0tracy0 6]

I'm really concerned because my surgeon seems to be too busy to complete the review. It's going on 3 weeks since I was actually denied.

[2nd Time Karen 8]

I love it when they want a PEER to PEER, that means that they are not fooling around with looking at reports, but willing to get the surgeons view and medical plan. these usually go in favor of the patient..

[audreae 7]

I'm approved!!!!!

[2nd Time Karen 8]

YAHHHHHHHH!!!

[0tracy0 6]

Congrats!!!!!!!!!

[0tracy0 6]

I was just denied again with the peer to peer review. My next step is to do an appeal.

[journeygrl 27]

I was just denied again with the peer to peer review. My next step is to do an appeal.

Did you surgeon ever fill out their part of the paperwork?

[0tracy0 6]

I guess so. They office just called me and told me that the peer to peer review was done and denied.

[journeygrl 27]

So sorry to hear that

[Not Applicable 52]

All is not lost. I was denied initially and then my doc submitted some more info and I was approved. I hope the same happens for you!

[audreae 7]

I'm sorry as well. Don't give up. Did they tell you why it was denied?

[0tracy0 6]

When I asked the lady at the office why I was denied, she had no clue. I think I need to find a different doctor.

[2nd Time Karen 8]

Get a copy of the denial letter and then maybe a 2nd opinion. I went through the same thing and the 1st doctors office did not go to bat for me, Although all of the tests that he ordered showed problems. When I went to 2nd doctor, she pulled all of the information together and made my case, even TO ME, because i was about ready to BUCK UP and forget about it. You need to KNOW the reason for the denial.