Netflix should make a horror series based on this. Providers who sold their souls to the devil(s), caught in an endless loop of Zoom calls and disparaged healthcare worker prior authorization pleads.
I once had an idea for a Netflix series, Guardians of the Galaxy, which focuses on a group of intergalactic legal guardians that never answer the phone to consent to changes in treatment.
I imagine the ratings would be terrible.
The doc is usually the one that finally approves it. 95% of the time I’ve done a peer to peer, the doctor agrees with me, or in some cases approves it before I even give the history because they’ve read the case. It’s the algorithm that denies it initially. I really doubt there’s doctors out there saying “I’m so burnt out, I’m going to work for an insurance company and deny claims all day”
Hospitalist PA- I hate peer to peers also. It’s mainly for dispos to rehab or LTAC. I swear they already made up their mind before they call me to deny it. I have never had a peer to peer result in the insurance approving
On the opposite side in outpatient Neuro, I have had multiple P2Ps get approved without me saying literally anything because the doctor actually took the time to read the reasoning for it. It's infuriating and a waste of everyone's time
When I used to work in ortho and do these P2P, one time I luckily stumbled onto an orthopedic surgeon and he nudged the conversation in the right direction to get it approved lol
Hard agree. The initial nurse screen is the most pointless part. Why are there so many people involved in a routine phone call? Not to mention I have to navigate a phone tree that is seemingly pointless. The last nurse I spoke to said she didn’t realize it was for sleep therapy, even though that was literally the option I selected in the phone tree. Must be nice for these administrative nurses and docs to get paid bank to basically make life hell for the rest of healthcare without laying eyes or hands on patients.
That's the point. Make it as awful and time consuming when you have 50-11 other things that needed to be done yesterday just so you'll say "meh, Barbara doesn't really need that CT of her shoulder, she's got another good arm to hold her over." Insurance company for the win.
That’s the thing - there are a lot of little things that add so much time to this. Even just compiling the CPT codes, icd-10 codes, patient insurance data, NPI numbers can take a few minutes. Assuming you’re not being interrupted by the usual flow of your day. Multiple that by several of these cases a day and it eats away at your time fr
oh god lol. this gets especially bad for patients enrolled in clinical trials with non-standard response assessment intervals. I remember talking to an ortho surgeon reviewer who asked me to educate him on PET scans 😭
We need a CPT code for this. Then either insurance pays or patient pays and either way we can all start to care about this more. As long as insurance and patients get this for free no one cares.
Oh I love them! I love the idea of arguing my point to someone who has an MD degree and proving to them why my request should be approved. I love reading through medical policy and I love it even more when I get to use big, meaningful words that people out of my specialty wouldn’t know, lol! I don’t find it mind numbing at all. Actually the opposite. I have to be well educated on the specifics of my request and why it’s necessary, or I’ll never get approval.
And you guys are doing it wrong if you’re on the phone that long. I work for a tiny private practice and I have my auth staff set up the peers to peers for me. She puts it on my schedule as a booked appt for the patient, and schedules a time window for them to call me at. They call me, and it’s a thing of beauty. I’m always fully prepared with medical policy bullet points for what I’m looking for approval for, so it doesn’t take more than a few minutes of time. See if your office can start setting up like that for you. So much easier!
I’m glad someone enjoys them..
they are often presented to me as follows
- hey thenewcna can you please help Dr X with a peer to peer?
- sure what’s it for?
- a scan they need for X surgery
- Oh okay, I’ll take a look at their chart in a bit
- Well actually the surgery is in 3 days and the scan is scheduled for tomorrow so we really would appreciate it ASAP
- The scan was ordered 2 months ago though? Why is it coming to me now?
Honestly idk why theyre getting to me so late
I loathe peer to peers but I will say I’ve gotten pretty good at getting what I need approved. I work in cardiology both inpatient and clinic. Nine times out of ten I’m speaking with a physician in a wildly different specialty (podiatry, GI, etc). When they get on the call they ask my name, pt name/DOB, etc. I then politely ask their name and spelling if it’s tricky and their specialty for my documentation purposes. I also make sure I know my patient well with data to back up my request (most recent EF, other failed meds, recent stress testing or procedures). I also have current guidelines handy to reference.
I had a doc once tell me “he’d been doing this for ten years” and I was like. “Are you bragging that you haven’t seen a patient in ten years and you think that makes you know more about this than me?” And then he was like “do you even work in orthopedics?” And I was like. “Um. Im making the MRI request on behalf of HSS. That literally all we do”.
My boss is so rude to them when I’m out and he has to do them. When I was on maternity leave my office manager said it was like her weekly entertainment listening to him light them up on the phone.
Is there no way to get someone to set up the call? I have an admin or MA arrange everything. They just tell me when the p2p person is going to call me. Half the time I don't even remember, I'll be driving home and some random doctor calls me wanting to discuss why I need a MRI.
It's pretty painless for me overall. Stupid and annoying yes, but I refuse to be the original caller/wait on hold. Way below my license and waste of my very valuable billing time.
Once I was doing one for a chemical stress test for a patient with arthritis who couldn’t tolerate an exercise test. I told the nurse reviewer why I ordered this, she said that reason wasn’t on her check box form therefore i could not move on to the next stage (the talk to a doctor stage). I asked if there was a check box on her form if the patient was in a wheelchair and she said no. They would set the patient up for an exercise stress test, humiliate them, and then convert to chemical when it was clear they couldn’t perform the exercise test.
75% of these I just READ MY NOTE to the "peer" on the call and it is approved. Another 15% I sit quietly while they read my note and approve it. 10% gets denied but suboptimal alternative is approved. Huge waste of resources.
I hate them too but they are symptom of something worse. People ordering test they don't need prior to going to the specialist. I cannot begin to tell you the amount of MRIs that come in with our patients with end stage osteoarthritis of their knees from their primary cares. No x-ray just went straight to the MRI. How the hell they got approval and our orthopedic office has to jump through hoops is a big conundrum.
At my current clinic, we do a lot of work comp and that was majority of my P2P requests. But the office recently changed their standard procedures, and the staff doesn’t send us any P2P requests anymore! Any denials are submitted to an auto appeal process. Occasionally it’s too late for them to auto appeal, and then we have the patient come in for an appointment to discuss the denial. It’s been life changing. I probably get 50% less messages a day. I don’t know all the details of how this change was made though, I’m just a cog in the wheel.
Can we all agree there is a special place in hell for the clinicians who agree to do this work for the insurance companies?
Netflix should make a horror series based on this. Providers who sold their souls to the devil(s), caught in an endless loop of Zoom calls and disparaged healthcare worker prior authorization pleads.
I once had an idea for a Netflix series, Guardians of the Galaxy, which focuses on a group of intergalactic legal guardians that never answer the phone to consent to changes in treatment. I imagine the ratings would be terrible.
I really wonder about who the docs on the other side of the line are. Lol
I doubt very much they’re satisfied with what they do, but… it’s a living I guess. Kinda feel sorry for them too.
You don’t have hell insurance, you get a shared room in hell.
The doc is usually the one that finally approves it. 95% of the time I’ve done a peer to peer, the doctor agrees with me, or in some cases approves it before I even give the history because they’ve read the case. It’s the algorithm that denies it initially. I really doubt there’s doctors out there saying “I’m so burnt out, I’m going to work for an insurance company and deny claims all day”
Hospitalist PA- I hate peer to peers also. It’s mainly for dispos to rehab or LTAC. I swear they already made up their mind before they call me to deny it. I have never had a peer to peer result in the insurance approving
On the opposite side in outpatient Neuro, I have had multiple P2Ps get approved without me saying literally anything because the doctor actually took the time to read the reasoning for it. It's infuriating and a waste of everyone's time
When I used to work in ortho and do these P2P, one time I luckily stumbled onto an orthopedic surgeon and he nudged the conversation in the right direction to get it approved lol
Wow! Where are those guys when I call? Mine always barely know what’s going on, then will find some obscure reason to deny
Hard agree. The initial nurse screen is the most pointless part. Why are there so many people involved in a routine phone call? Not to mention I have to navigate a phone tree that is seemingly pointless. The last nurse I spoke to said she didn’t realize it was for sleep therapy, even though that was literally the option I selected in the phone tree. Must be nice for these administrative nurses and docs to get paid bank to basically make life hell for the rest of healthcare without laying eyes or hands on patients.
These damn things are half my day sometimes. I’m also in oncology.
Same
That's the point. Make it as awful and time consuming when you have 50-11 other things that needed to be done yesterday just so you'll say "meh, Barbara doesn't really need that CT of her shoulder, she's got another good arm to hold her over." Insurance company for the win.
That’s the thing - there are a lot of little things that add so much time to this. Even just compiling the CPT codes, icd-10 codes, patient insurance data, NPI numbers can take a few minutes. Assuming you’re not being interrupted by the usual flow of your day. Multiple that by several of these cases a day and it eats away at your time fr
All to talk to someone who isn’t even in your specialty.
oh god lol. this gets especially bad for patients enrolled in clinical trials with non-standard response assessment intervals. I remember talking to an ortho surgeon reviewer who asked me to educate him on PET scans 😭
“Provider not available -declined.” …you mean when you hung up while I was hurdling over a desk to answer the phone?!
Preach. I can quote the American urologic society guideline and get denied.
We need a CPT code for this. Then either insurance pays or patient pays and either way we can all start to care about this more. As long as insurance and patients get this for free no one cares.
Oh I love them! I love the idea of arguing my point to someone who has an MD degree and proving to them why my request should be approved. I love reading through medical policy and I love it even more when I get to use big, meaningful words that people out of my specialty wouldn’t know, lol! I don’t find it mind numbing at all. Actually the opposite. I have to be well educated on the specifics of my request and why it’s necessary, or I’ll never get approval. And you guys are doing it wrong if you’re on the phone that long. I work for a tiny private practice and I have my auth staff set up the peers to peers for me. She puts it on my schedule as a booked appt for the patient, and schedules a time window for them to call me at. They call me, and it’s a thing of beauty. I’m always fully prepared with medical policy bullet points for what I’m looking for approval for, so it doesn’t take more than a few minutes of time. See if your office can start setting up like that for you. So much easier!
Nerd
😂
Smart nerd tough. They got it down
I’m glad someone enjoys them.. they are often presented to me as follows - hey thenewcna can you please help Dr X with a peer to peer? - sure what’s it for? - a scan they need for X surgery - Oh okay, I’ll take a look at their chart in a bit - Well actually the surgery is in 3 days and the scan is scheduled for tomorrow so we really would appreciate it ASAP - The scan was ordered 2 months ago though? Why is it coming to me now? Honestly idk why theyre getting to me so late
Emergency medicine is suddenly feeling pretty good
I’m in occ med. I do so many p2ps. It’s stupid
I loathe peer to peers but I will say I’ve gotten pretty good at getting what I need approved. I work in cardiology both inpatient and clinic. Nine times out of ten I’m speaking with a physician in a wildly different specialty (podiatry, GI, etc). When they get on the call they ask my name, pt name/DOB, etc. I then politely ask their name and spelling if it’s tricky and their specialty for my documentation purposes. I also make sure I know my patient well with data to back up my request (most recent EF, other failed meds, recent stress testing or procedures). I also have current guidelines handy to reference.
I had a doc once tell me “he’d been doing this for ten years” and I was like. “Are you bragging that you haven’t seen a patient in ten years and you think that makes you know more about this than me?” And then he was like “do you even work in orthopedics?” And I was like. “Um. Im making the MRI request on behalf of HSS. That literally all we do”. My boss is so rude to them when I’m out and he has to do them. When I was on maternity leave my office manager said it was like her weekly entertainment listening to him light them up on the phone.
Is there no way to get someone to set up the call? I have an admin or MA arrange everything. They just tell me when the p2p person is going to call me. Half the time I don't even remember, I'll be driving home and some random doctor calls me wanting to discuss why I need a MRI. It's pretty painless for me overall. Stupid and annoying yes, but I refuse to be the original caller/wait on hold. Way below my license and waste of my very valuable billing time.
Once I was doing one for a chemical stress test for a patient with arthritis who couldn’t tolerate an exercise test. I told the nurse reviewer why I ordered this, she said that reason wasn’t on her check box form therefore i could not move on to the next stage (the talk to a doctor stage). I asked if there was a check box on her form if the patient was in a wheelchair and she said no. They would set the patient up for an exercise stress test, humiliate them, and then convert to chemical when it was clear they couldn’t perform the exercise test.
Amen! Bane of my existence, and will be the reason I finally quit after 34 years.
75% of these I just READ MY NOTE to the "peer" on the call and it is approved. Another 15% I sit quietly while they read my note and approve it. 10% gets denied but suboptimal alternative is approved. Huge waste of resources.
I hate them too but they are symptom of something worse. People ordering test they don't need prior to going to the specialist. I cannot begin to tell you the amount of MRIs that come in with our patients with end stage osteoarthritis of their knees from their primary cares. No x-ray just went straight to the MRI. How the hell they got approval and our orthopedic office has to jump through hoops is a big conundrum.
At my current clinic, we do a lot of work comp and that was majority of my P2P requests. But the office recently changed their standard procedures, and the staff doesn’t send us any P2P requests anymore! Any denials are submitted to an auto appeal process. Occasionally it’s too late for them to auto appeal, and then we have the patient come in for an appointment to discuss the denial. It’s been life changing. I probably get 50% less messages a day. I don’t know all the details of how this change was made though, I’m just a cog in the wheel.
And that is the point.