Guides · Any · Peer-to-peer review
Peer-to-Peer Review: What It Is and How to Ask for One
A peer-to-peer lets your doctor talk directly with the plan's medical reviewer. Here's how to request it.
A peer-to-peer review is a phone conversation between your clinician and the insurer's physician reviewer. Many plans offer it for prior authorization denials, often within a short window after the denial, and it can sometimes resolve a denial faster than a written appeal.
Free sample appeal paragraph
[To your doctor's office] Could you please request a peer-to-peer review with [plan] regarding the denial of [service], reference [number], dated [date]? The denial cited [reason]. The key points are [points]. Please let me know if you need anything from me.
Replace the [brackets] with your details. This is a starting point, not legal advice.
What to do
- Ask your doctor's office promptly, since windows can be short.
- Give the office the denial letter and the reason quoted.
- A peer-to-peer doesn't replace your written appeal deadline, so track both.
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Start the free checkFrequently asked questions
Can I do the peer-to-peer myself?
No. It is clinician to clinician. You can help by preparing your doctor's office.
Does it pause my appeal deadline?
Generally no. Keep track of the written appeal deadline on your notice.
How do I appeal a peer-to-peer review denial?
Start with the instructions and deadline on your denial letter. Gather your medical records and a letter of medical necessity, respond directly to the stated denial reason, and file an internal appeal. Keep proof of submission.
Is external review available?
For many non-grandfathered plans, independent external review may be available for denials involving medical judgment after a final internal denial, generally within 4 months. Confirm on your denial notice.
Related guides
- ACA Internal Appeal Deadlines Explained
- ACA External Review: How It Works
- Medicare Advantage Organization Determination Appeals
- How to Appeal a Medicaid Denial (Plan Appeal and State Fair Hearing)
- How to Appeal a Medicare Part D Drug Denial
- How to Appeal an Employer Health Plan Denial (ERISA Plans)
- All appeal guides
Document preparation / educational use only. This site is not a law firm, regulator, airline, insurer, or parking operator. Nothing here is legal advice. Outcomes are never guaranteed. Review every letter carefully before sending and consult a licensed professional if you need advice about your situation.