HELP!!!!

from my understanding a Peer to Peer is here your doctor talks to a medical rep from the insurance company.                                              Annie

A peer to peer review is when your surgeon talks directly to the medical director (another Dr) at the insurance company. (the medical director heads over the dept that reviews requests for approval). You would have to call your insurance company to find out what the appeals process is, if they do peer to peer reviews and when they allow them.  Typically a peer to peer review is done if a request for services is denied and the Dr feels its urgent it gets approved so the procedure can be done asap. Also typically with a peer to peer - whatever decision is made is final... so that would end your appeal process. Sometimes the insurance will not do a peer to peer if it is not an urgent issue. As a side note some surgeons prefer not to do a peer to peer review... since its a phone call they have to schedule and be on for an extended length of time (could be 1+ hours). Also if they do it for one patient then they would have to do it for others and basically could end up being on the phone all the time - you get the idea Im sure :-)

Peer to peers are as stated below, however they don't always have to be for urgent cases or anything that has to be done asap. Most peer to peers I have seen exp is it normally takes about 10 - 30 mins and most surgeons who back their patients will do the peer to peer w/ no problems. It never hurts to ask. Again it depends on the denial is for will depend on if your surgeon can do it, is it medically like would your pcp be able to do it for you better? These are all things to think about. But don't think your surgeon is too busy or don't have the time. They all have admin time each week and it's just a matter of scheduling. The insurance company normally has someone to talk at anytime.  Also if you insurance has the BMI limit there might not be much anyone can do....but it's worth the fight no matter how far you have to go. Good Luck and please don't give up!!!!!

Welcome -  I'm sorry that your being denied.  I'm suprised that dr b would let you get this far in the process only to be denied.  I would definitly expect them to do everything they can to help with your appeal, since they are the experts. Do you mind telling us what insurance you have?  I'm not firmilar with Max BMI's or anything. Please hang in there, this is so worth the fight!!  You will be on the loosers bench soon.  Please keep us informed. Jen

I would like to thank everyone for their help, input, and words of encouragement.  My insurance provider is MedCost preferred PPO thru CHS (carolinas healthcare system).  Lift me up in prayer.  Thanks ,  Wanda

I am sorry for your denial. Please don't give up. I don't have any suggestion except fight.  Best wishes and many prayers to you, Myrtis