Advertisement

What is a peer-to-peer review with my insurance company?

Not to be confused with a medical peer review, this is solely something that happens when a request for services has been denied by the insurance company.

This can also be called a "doc to doc" appeal, this is typically a phone conversation between a physician at an insurance company (the one that's refusing to pay for services) and the patient's attending physician (the one whose requesting services). 

Anyone on the patient's team (social worker, case manager, why, even, believe it or not, the patient himself!) can initiate this with the insurance company when a request has been denied, but it's infinitely better to make sure your doctor handles the conversation.

Often times, getting the two doctors on the phone can make a world of difference to the initial denial.  One of our patients had been routinely denied acute rehab after his open heart surgery which was not at all routine.  When the patient's cardiologist got on the phone with the insurance doctor reviewing the case, she shared critical clinical and surgical information that the insurance doctor was not aware of. Once she heard the unusual circumstances, she immediately approved the rehab.

Continue Learning about Health Insurance

News: US Uninsured Rate Climbs Above 12%
News: US Uninsured Rate Climbs Above 12%
According to recent research by Gallup and Sharecare, the percentage of US adults without health insurance increased to 12.3 percent during the third ...
Read More
What is an annuity?
Ric EdelmanRic Edelman
The term annuity simply refers to a stream of income. Pensions and Social Security benefits, for exa...
More Answers
What long-term needs should I consider when reviewing my life insurance?
Philip Lisagor, MDPhilip Lisagor, MD
When reviewing your long-term life insurance coverage needs, you should consider: How many peopl...
More Answers
How Does the Healthcare System Cope with More People Being Added?
How Does the Healthcare System Cope with More People Being Added?

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.