Personal experience with insurance company today:
Requesting a peer to peer, you have less than 24 hours to call or the request for inpt rehab will be denied.
Call
P2p: this is a recorded line, my ID# xxxx
We are denying the application for rehab because of X reason... continues,
[does not give a chance for me to respond]
...
[I interject]
Me: youre justifying denying the application because of a document from 5 days ago and ignoring all of the other indications for rehab including [Y], [Z], also i have the patients family and medical decision maker here with me as I believe that patients should be involved in their care.
P2p: im sorry dr [a] but it is against our company policy for anyone but you and I to be involved in this conversation, if you cannot abide by these rules then I cannot continue this conversation.
Me: whats your specialty? Whats your name?
P2p: I cannot release that information, you have been given my id #, that will work if this file needs to be referenced.
Me: so youre using outdated information from 5 days ago, to deny an application, you won't let the patient or their family be a part of this conversation, you won't tell me your name or credentials, what about this is fair, and how is this even a peer to peer? I dont know you are who you say you are, you could be someone with no medical education for all I know.
P2p: please address me with the respect I deserve.
Me: please provide your credentials so I can address you with the respect you deserve. This patient has needed [b, c, d] and studies have shown that people at [pts age] with [pts condition] respond very well to rehab and not getting it harms the pt.
P2p: dr [me] if I may, based on the information you have provided we will approve this request.
Me: thanks, bye.
TLDR: insurance are refusing to allow pts to be involved in p2p conversations about pt care, they are refusing to release their information to prove it is a peer, they are using outdated information to deny claims/applications. Just so you all can prepare for your next p2p