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For the Americans, might help.
(lemmy.ca)
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this post was submitted on 08 Dec 2024
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Mildly Interesting
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Usually this is a tactic some doctors do for a peer to peer, but generally you ain't getting a peer to peer as a patient. Peer to peers use unqualified doctors to question treatment at a time convenient to the insurance company in the hope that your doctor decides "this isn't worth my time, the patient needs to figure their own shit out." Importantly, you can't bill for the time spent on this shit. If they made it legally required to allow billing, it would disappear.
This is advice for doctors, not patients.
Usually doctors do the peer to peer and then the patient can appeal once services are denied (which is almost always the case if you've reached the peer to peer stage).
I've used this before with mild succees. It's far from reliably effective. You're more likely to get the decision over turned at the appeal stage, the problem being that precious time is lost while going through that process.
I do like to schedule an appointment so that patients are part of the peer to peer call. That way they can tell the doctor, nurse, PA, NP or whichever other service reimbursement bouncer the insurance company has hired that they're putting a curse on them and their family.