WASHINGTON, D.C. – In a revision of terminology that better reflects the non-chummy reality of insurance denials and the appeals that follow, the phrase “peer-to-peer review” will be dropped for the more accurate term “enemy-to-enemy review.”
“You think the idiot I’m trying to reach at the insurance company is my friend? Hell no!” explained Dr. Edina Mercer, a hospitalist at Washington Medical Center who has lost all of her hair due to prior authorizations alone. She’s on the other line, hoping a “peer” will pick up. “They’re not my peers; a peer is someone working with me in the trenches here at the hospital. This is enemy-to-enemy.”
Mercer is right. If anyone actually ranks lower on the totem pole than a first-year medical student, it’s an insurance company.
For those unfamiliar, a peer-to-peer review is something that can be initiated when an insurance company denies a request for services, which happens no less than all the time. Anyone on the medical team can initiate the peer-to-peer, but it tends to involve two health care professionals: the one caring for a patient, and the one working at the insurance company. Assuming you can reach someone at the insurance company.
“Let’s say for argument’s sake that the ‘peer’ at the insurance company is actually a friend, someone I went to medical school with, you know what I would say? You suck, that’s what I’d say, because you can tell a friend anything,” Mercer continued. She is still on hold, the annoying hold music making her bleed from the ears. “A true to peer-to-peer would involve us saying things like, how’s life? how are the kids? are we still on for that BBQ? With this, I just want to scream at the top of my lungs and hang up.”
Fifteen minutes later, Mercer still hadn’t reached her peer. She screamed at the top of her lungs and hung up, just as predicted.