The Power of a Peer to Peer Review
“I work with an office that takes a lot of union plans, and these plans are the worst about paying out on major treatment. The doctor does a lot of onlays and there was one patient that had 4 of them denied for necessity by a union plan. I sent two appeals with clinical notes, x-rays, and intra-oral photos but both were denied. The patient even called the insurance to file a patient appeal and they told him it would still not be overturned.
Finally, I spoke with a supervisor and asked him if we could get a peer to peer review. The supervisor said they would call the office the following week, but wouldn’t give me a specific day or time. Two months after requesting the peer to peer review, the insurance finally cut the office a check and paid for all of the treatment! The patient was elated and said a huge weight had been lifted off his shoulders.”