Peer Review, What is it???

I have seen a few questions lately on peer review, so I will try to answer them in one spot, to the best of my ability. Peer review is offered in some cases where the insurance company, allegedly has to be "shown" by convincing evidence that the surgery is medically necessary. It is not mandatory nor is it included in every policy.  You should read your policy and denial letters to determine whether it is available. The question then becomes, should you participate?  Well, its not you that would be participating it would be your surgeon.  I can tell you that I personally know of many top notch surgeons *****fuse to conduct peer reviews for two reasons.  1. They rarely result in an overturned denial, and 2. it can get very confrontational and it drives the surgeon crazy.   Think about it.  two medical professionals are going head to head.  One is a skilled bariatric surgeon who has performed hundreds, if not thousands of surgeries each year.  The other, probably a skilled physician, but not a bariatric surgeon.  In fact, many who claim to be bariatric surgeons are simply members of the American Socirty for Bariatric Surgey,  They have taken the training classes, maybe performed or assisted on a few surgeries, but in reality or simply general surgeons, while in their own right skilled, but have no business reviewing bariatric surgery requests. Therefore you should do the following: 1. If a peer to peer is offered, speak with your surgeon about how he/she feels about such reviews. 2. If it is accepted, make sure you get the name and qualifications of the insurance companies doctor. and 3. Make sure that the review, and any documents provided during or after the review to the insurance company is not considered an appeal of your denial thereby wasting one of your appeals. So, be patient.  But understand, peer reviews usually are not the end of the line.  So fight the good fight. Gary