Are the peer-to-peers often difficult or are they a formality?

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Aug 18, 2022
3:52:11pm

Tokolosh All-American

My son's knee surgery was denied but the surgeon did a peer to peer and had it resolved in a couple of minutes.

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Tokolosh

Bio page: Tokolosh
Joined: Jun 9, 2004
Last login: May 2, 2024
Total posts: 60,465 (5,642 FO)

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Messages

Author

Time

Without too many details so as not to violate hipaa I want to vent about how insurance companies kill people

Slim Intervention Needed

8/18/22 3:48pm

🤬

Solomon Levi

8/18/22 3:50pm

Humana, right?

bluecheese

8/18/22 3:51pm

Sounds like Kaiser

BYU Grounds

8/18/22 4:14pm

Not in Utah, but yes.

specsauce

8/18/22 4:23pm

<< Deleted >>

cougfanz

8/18/22 4:38pm

Didn’t understand at first as I was thinking…IHC doesn’t accept Kaiser PPO, but I reread and understand what you’re

specsauce

8/18/22 5:37pm

Are the peer-to-peers often difficult or are they a formality?

Tokolosh

8/18/22 3:52pm

They are very time consuming, and while the insurance doctor is making money

Zoobieman

8/18/22 3:54pm

And they probably took an hour out of their day

cougarbart

8/18/22 3:54pm

About 90% of the time they’re approved for me. But it’s phone trees and

cougfanz

8/18/22 4:05pm

Very difficult, time consuming, peer doctor often a straight up jerk

Slim

8/18/22 4:08pm

They are a time consuming formality.

5150man

8/18/22 4:10pm

Annoying, time consuming, and the doctor doing it is usually an idiot or a jerk

Medute

8/18/22 4:21pm

You can almost guarantee that any doctor working for an insurance company is a yes man/ woman

BIG XII Coug

8/18/22 5:00pm

Or they hated private practice and want an easier job that pays well

D.T. Survivor

8/18/22 5:10pm

Insurance companies can go to Hell.

byuluvr

8/18/22 3:52pm

High probability……

Bluedomination

8/18/22 4:07pm

It’s funny because hospitals are trying to be insurance companies and now

cougfanz

8/18/22 4:09pm

Reminds me of when my nephew was vomiting multiple times a day, passing out, had

vagabonder

8/18/22 3:54pm

Sometimes I have to remind myself, Insurance = Contractual obligation to pay

Zoobieman

8/18/22 4:13pm

Amazing that companies selling a product we're mandated to have who charge us

vagabonder

8/18/22 4:20pm

It is very sad. . . I am seriously considering going into Direct Primary Care.

Zoobieman

8/18/22 4:35pm

So a clown was more helpful than the insurance company. Things need to change

Cougsanity

8/19/22 8:33am

Medical insurance is a cluster

kotacoug

8/18/22 4:06pm

Few things I hate more than insurance companies claiming observation status

cougfanz

8/18/22 4:07pm

Who cares what they say?! Patient is suffering. If there are negative

Six Foot Seven

8/18/22 4:09pm

Or are there additional considerations that I wouldn’t know about or appreciate?

Six Foot Seven

8/18/22 4:11pm

<< Deleted >>

cougfanz

8/18/22 4:11pm

Huh? I’m mad the insurance company wants me to either kill the patient (which I’m not going to do) or the patient will

Slim

8/18/22 4:13pm

Yeah thst sucks. At least we have bankruptcy.

EternalOptimism

8/18/22 4:48pm

The doctors will pretty much always do what’s right for the patient when it’s clear cut.

5150man

8/18/22 4:13pm

1 year ago I found out one of my best friends was experiencing kidney failure, and was maybe going to last a week or 2

jdub

8/18/22 4:13pm

I can’t get meds more than 30 days in advance because of insurance

D.T. Survivor

8/18/22 4:15pm

Not sure if you've seen these or if it's even an available drug, but Mark Cuban

Blue Golfer

8/18/22 5:00pm

Do you know if HSA can be used? I think they allow supplements so I would

D.T. Survivor

8/18/22 5:11pm

I just reviewed the FAQ page. FSA/HSA are accepted forms of payment. 👍🏻

Blue Golfer

8/18/22 5:14pm

I've said time and again to patients and colleagues alike, insurance companies

Blue Golfer

8/18/22 4:16pm

I had sudden deafness in my left ear a few years ago. The doctor said that in

Bambino

8/18/22 4:33pm

The most infuriating and stupid part about your experience is that the insurance

Blue Golfer

8/18/22 4:52pm

I agree. This is asinine. Medical necessity shows that not only should the patient be in the hospital, but basically

specsauce

8/18/22 4:23pm

This is a lesser claim but insurance companies are absolutely responsible for

Cabadapeste

8/18/22 4:25pm

Insurance and government kill innovation

D.T. Survivor

8/18/22 5:13pm

Get government out of medical insurance. Offer insurance on free market

kotacoug

8/18/22 5:31pm

That’s an interesting thought to uncouple it from employers

D.T. Survivor

8/18/22 7:46pm

I had almost the exact same story once in my career. The patient died the 4th night after the bleeding that we couldn't

doctorcoug

8/18/22 7:11pm

Have you done the "peer to peer"? I have several personal health issues where the insurance company denied at first...

Greg Kite's 'stache

8/19/22 7:58am

Simple and a few extra minutes don't describe peer to peer. Plus, imagine telling a doctor that they are an idiot for

doctorcoug

8/19/22 9:43am

Employers give physicians 15 minutes to see each patient. Within that window you

cougfanz

8/19/22 9:59am

Then people say we need socialized medicine without realizing you will have to

kotacoug

8/19/22 10:23am

Oh, I just wouldn't do it 🙂 To me, I'm basically already in that type of work

cougfanz

8/19/22 10:29am

A peer to peer requires significantly more time than 5 minutes and is universally a very painful experience. They are

Slim

8/19/22 12:21pm

All this while insurance company values keep increasing substantially. Dumb.

Bin01015

8/19/22 11:39am

My favorite recent one is a surgery I did on a patient was prior-authorized.

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