How to Request a Peer-to-Peer Review with Insurance
A peer-to-peer review lets your doctor speak directly with the insurance company's medical director. This can resolve denials faster than a written appeal.
What Is a Peer-to-Peer Review?
A peer-to-peer (P2P) review is a phone conversation between your treating physician and the insurance company's medical director or reviewer. It gives your doctor a chance to explain why the treatment is medically necessary.
When to Request P2P
- After a prior authorization denial
- When the denial is based on medical necessity
- When written appeals are slow and treatment is urgent
- When you believe the reviewer didn't understand the clinical situation
How to Request P2P
- Your doctor initiates the request — patients cannot request P2P directly
- Call the number on the denial letter — ask for a peer-to-peer review
- Most insurers require scheduling — allow 3-7 business days
- Some states mandate P2P — check your state's requirements
Preparing for the Call
Your doctor should prepare:
- Clinical summary of the patient's condition
- Specific guidelines supporting the treatment
- Documentation of failed alternatives
- Clear articulation of why the denied treatment is medically necessary
- Understanding of the insurer's specific denial reason
Tips for Success
The most successful P2P reviews are concise and focused on the specific denial reason. Your doctor should avoid general arguments and instead directly address why the insurer's criteria are met or should not apply.