Peer to peer

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Iamnew2

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What do you all do when you have to talk with clueless physicians from the insurance company who are not in your specialty? recently talked to a clueless doctor and i asked her her name, contact info and specialty. She got pissy and told me "we are done here" and I said well clearly this is the wrong decision or something like that and I want to know i'm talking to someone in my same specialty. She called me a few minutes later to tell me she reconsidered her decision and she was approving our request.
Arent these docs supposed to a) know what they are talking about and b) actually be in your same specialty? how is that a peer to peer otherwise? and why do they get pissy when one asks for their info? I think it makes sense. I want to note it in my note so that if crap hits the fan they know who to talk to particularly when the insurance is being ridiculous and unsafe as well as bull headed.

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I’m fortunate to not have to do many peer to peers in our area. Rarely is it actually peer-to-peer, meaning physiatrist to physiatrist. But I think they’ve always been an MD or DO. So I always win because I talk about their functional status and the person really doesn’t know what their talking about, so they say “ok, I’ll go ahead and approve one week for now.”

I did have one true P2P where the other doc was an attending I worked with in med school in an away rotation. We chatted for a bunch and he said he’d just go ahead and give auth, then told me how I could do in’s auth reviews. He missed being a clinical doc and took the job so he could work at home and care for aging parents, but he thought reviewing a few cases a week would be helpful learning experience for me.
 
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What do you all do when you have to talk with clueless physicians from the insurance company who are not in your specialty? recently talked to a clueless doctor and i asked her her name, contact info and specialty. She got pissy and told me "we are done here" and I said well clearly this is the wrong decision or something like that and I want to know i'm talking to someone in my same specialty. She called me a few minutes later to tell me she reconsidered her decision and she was approving our request.
Arent these docs supposed to a) know what they are talking about and b) actually be in your same specialty? how is that a peer to peer otherwise? and why do they get pissy when one asks for their info? I think it makes sense. I want to note it in my note so that if crap hits the fan they know who to talk to particularly when the insurance is being ridiculous and unsafe as well as bull headed.
I basically do what you did: get the name, contact, license number, etc. so I can document it in the notes.

Thankfully, I have not had to do anything close to that in the past couple of years.
 
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I basically do what you did: get the name, contact, license number, etc. so I can document it in the notes.

Thankfully, I have not had to do anything close to that in the past couple of years.

I frequently am successful, but I found it so atrocious when I talk to someone so clueless. When I asked for the doctor's contact info, she tells me "no you may not have my contact information." She even says "you are threatening me." I said, umm I'm threatening you because I'm asking you for your name, contact info and specialty? *me confused*
Is there a nicer way to say, please can you provide me with your name, contact info and specialty? I was so shocked and confused. These insurance jobs also don't pay that well, so for these docs to sell their soul like that for a few bucks seems odd. They pay like 180k plus discretionary bonus.
 
Just try to not get invested too much into the encounter. Reviewers who are new are usually the hardest to talk to and most stubborn about denying everything (trying to meet quotas I presume?).

Some days I win peer-to-peer with no effort. Even in cases that I thought they would deny and I really had no argument.
Other days, I have a strong argument and fight off all their counter-arguments and they still deny just on spite. Most of these I think they would overturn in the case of an appeal, but they know most people won't go through with and appeal.

I haven't asked a reviewer for contact information, but I don't think they would give you that. Just a generic number for the insurance company. I believe a reviewers specialty can be anything and there likely aren't too many PM&R docs doing peer reviews for insurance companies (have only talked to a handful thus far).

When I first started doing reviews, there were a few times where I would get too upset at the reviewer. I've learned to just present facts from the case in an organized matter and try to do the best I can for the patient. Then politely disagree and re-presenting my facts for the case or add new argument. I know I won't win them all. But I also know an appeal is an option in most cases for the patient, so they fight may not be over.
 
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Just try to not get invested too much into the encounter. Reviewers who are new are usually the hardest to talk to and most stubborn about denying everything (trying to meet quotas I presume?).

Some days I win peer-to-peer with no effort. Even in cases that I thought they would deny and I really had no argument.
Other days, I have a strong argument and fight off all their counter-arguments and they still deny just on spite. Most of these I think they would overturn in the case of an appeal, but they know most people won't go through with and appeal.

I haven't asked a reviewer for contact information, but I don't think they would give you that. Just a generic number for the insurance company. I believe a reviewers specialty can be anything and there likely aren't too many PM&R docs doing peer reviews for insurance companies (have only talked to a handful thus far).

When I first started doing reviews, there were a few times where I would get too upset at the reviewer. I've learned to just present facts from the case in an organized matter and try to do the best I can for the patient. Then politely disagree and re-presenting my facts for the case or add new argument. I know I won't win them all. But I also know an appeal is an option in most cases for the patient, so they fight may not be over.

I just don't like when they have the completely wrong information and they insist on it. I had one reviewer insist that the patient had been in rehab for 35 days - when he was at the acute care hospital. I corrected him yet he still put this on the denial. Then we appealed and the appeal was won. It's just such a waste of time.
 
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