I had to do an unpleasant peer to peer medical review recently for a test, and I was trying to think of ways to improve or even abolish the system of peer to peer medical reviews. Ultimately, calling and being placed on hold 20 minutes to schedule a peer to peer a few days later, and then having a 15 minute discussion with the reviewer was a complete waste of time as the study was approved.
One thing that I think should be done is for all peer to peer medical review conversations to be recorded and mandated to be kept by the insurer in the patient's file. The recording should be promptly available for the patient to review. This way, the patient and any potential future legal action could review what was discussed to proceed forward.
I also think the peer to peer reviewer should not have any financial ties to the insurance company aside from the peer review process. The reviewer should also not get any incentives for percentage of tests denied/approved.
Can you think of any ways of how to get the peer to peer review system reformed?
One thing that I think should be done is for all peer to peer medical review conversations to be recorded and mandated to be kept by the insurer in the patient's file. The recording should be promptly available for the patient to review. This way, the patient and any potential future legal action could review what was discussed to proceed forward.
I also think the peer to peer reviewer should not have any financial ties to the insurance company aside from the peer review process. The reviewer should also not get any incentives for percentage of tests denied/approved.
Can you think of any ways of how to get the peer to peer review system reformed?
