You’ve done everything you’re supposed to do to prepare for your upcoming procedure; made sure the doctor and facility are in network, requested a pre-treatment cost estimator, and even gave the insurance company your procedure CPT codes.
Everything seems to be running smoothly when suddenly, you receive a letter in the mail from your insurance carrier requiring something called a ‘peer-to-peer review’. Frustrated and confused, you wonder,
“What on earth is a ‘peer-to-peer review’?!”
A peer-to-peer review is when your doctor talks directly with the medical board of directors of your insurance carrier to justify, solidify, and confirm the reason for your procedure and the expected outcome.
If you receive this type of letter from your insurance carrier, it’s important that you call your doctor’s office ASAP so they can get the ball rolling so that your procedure isn’t delayed.
If you have any questions regarding a peer-to-peer review, or you would like an employee benefits quote, give Clevenger Insurance a call today at 574-267-2181.