How to Prepare for a Peer-to-Peer Review
A peer-to-peer review is a phone call between your treating physician and the insurance company's medical reviewer. It's often the fastest way to overturn a denial — but only if your doctor is prepared.
What Is a Peer-to-Peer Review?
When your claim is denied for medical necessity, your doctor can request to speak directly with the insurer's medical reviewer. This physician-to-physician conversation can resolve denials without a formal written appeal.
When to Request
- After a prior authorization denial
- After a medical necessity denial
- When concurrent review cuts off treatment
- Before filing a formal appeal (can save time)
How to Prepare Your Doctor
Before the Call
- Know the denial reason — provide the exact criteria cited
- Prepare talking points — specific clinical data, test results, and guidelines
- Have records accessible — the reviewer may ask detailed clinical questions
- Know the reviewer's specialty — your doctor should be prepared to explain across specialties
- Cite guidelines — have relevant clinical guidelines ready to reference
During the Call
- Be concise and clinical — focus on medical facts
- Address the specific denial criteria directly
- Provide context the reviewer may not have from written records alone
- Ask what additional information would change the decision
- Take notes during the conversation
After the Call
- Request written confirmation of the outcome
- If still denied, the conversation strengthens your formal appeal
- Document what was discussed and any commitments made
Tips for Success
- Schedule the call promptly — delays weaken your position
- If your doctor can't reach the reviewer, document every attempt
- Some insurers make scheduling deliberately difficult — persist
- The peer-to-peer overturns denials approximately 30-50% of the time