Peer to Peer Review (x-post from Insurance Board)

Hi everyone!

Just wondered how many people had success with a  peer to peer review with their surgeon and the insurance medical director?

My insurance has not "denied" my surgery but stated that they needed more clinical information.  My surgeon is working on scheduling a peer to peer review.  I am scheduled to have my lap band removed, a hiatal hernia repaired and revision to RnY to treat severe acid reflux with esophageal erosion and ulcerations.  I have United Healthcare Choice plus and my surgery is tentatively scheduled for May 11th.

Any in site anyone has with the success of the peer to peer review process would be greatly appreciated! 

I didn't have a peer to peer review, however our cir****ances are similar.  My doctor requested an RNY revision surgery and repair of my hiatal hernia with the medical reason being severe acid reflux.  The good news for me was my insurance (Blue Shield PPO) approved my surgery the first time it was requested.  I had surgery 4/8/09 and couldn't be happier with the results thus far.  I've lost about 25 lbs. so far and feel better everyday.  I think its great your physician and the medical director of your insurance company will be doing a peer to peer review as your physician will have an opportunity to go into more detail as to why he feels the revision surgery is medically necessary in your case.  I will say a prayer that the peer to peer review goes in your favor. 

Lalala2

Thank you so much for the well wishes!  I am keeping my fingers crossed and saying a little prayer that it will be approved.  Did your insurance pay for your band?  I am SO ready to be done with this band.  I know it works for some people, but it has created so many problems for me!
 
Anyone have any experience with a peer to peer review?

My original surgery was an RNY and I was revised to an RNY.  Good luck!
Lalala2