Question:
Can anyone give me any tips about a Peer to Peer Review?
— Anniee M. (posted on September 4, 2003)
September 5, 2003
Can you give us a little more information? A review for what?
— Wendy D P.
September 5, 2003
I was denied by the notorius CIGNA HMO due to the last of 2 26 weeks diet
programs. I do have this information some of the documentation I just
recieved from Jenny Craig last week. So when CIGNA initially reviewed my
info that didn't have it. Because my surgery is at the end of this month I
decided to take the documentation to my Doctor's office and have him do a
peer-to-peer review to overturn my denial. This usually takes a couple of
days for the to say yes or no.
— Anniee M.
September 5, 2003
I do the approvals for my doctor. I know that I have had a few patients
that Cigna said "did not meet requirements". I have been able to
have my doctor do a peer to peer review with the insurance company. The
surgeon will talk to a medical director and besically tell them why this
patient needs surgery. They sorta talk the ins comp into approving the
patient. The few I am thinking about were all approved after the peer to
peer review. Good Luck
— Mandybub
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