Rude on Peer to Peer

[Bdoc]

So obviously i hate P2P(this one was to justify an admission vs observation). And usually its pretty obvious and we agree. For the first time in a while, the doctor on the other side disagreed with me. The conversation got heated and i kind of enjoyed it.

Nothing like 2 strangers getting in fight over no reason(my salary does not change weather i win p2p)

Should i be more polite next time or is it ok to get aggressive?

[DrRab]

I used to get really fired up and really get into the argument to the point where my MA would say I sounded scary. Especially when the “peer” was a family medicine doc or nurse with very limited knowledge of the subject matter. I have since adopted a killing with kindness approach, imagining myself speaking softly but carrying a big stick.

The whole prior auth issue is really starting to burn me out though…

[Hawkeye225]

Interesting topic since I just posted a short comment about disability insurance. While I was out on disability, I worked for a 3rd party company for a few years and part of it was peer to peer. I totally enjoyed the work except for the rare occasion when there was a belligerent doctor on the other end which happened three times. I completely understand the frustration that the docs have with the pre auth process for a number of reasons but on the other hand, the amount of inappropriate testing requests is astounding. I am about as easy to work with as anyone and enjoyed helping the doctors quite a bit and was good enough at what I did they asked me to consider moving into an executive track but I declined and was able to go back to clinical work.

Bottom line...there are some not great docs on the insurance side just as in clinical medicine but the vast majority are good people trying to do their best within generally reasonable guidelines and like clinical medicine, with poor systems and IT support. My recommendation is to be as pleasant as possible.

[Max Power]

Well, basically no doc ever has actually LOST a peer-to-peer, so I see no reason to be an a-hole to the other doc who's simply trying to cash a check.

I have also never had a prior auth peer-to-peer that took over 5mins (usually much less).

I usually just ask them what their specialty WAS (most are semi-retired or somehow lost their license) or where they did residency. This accomplishes reminding them that they are NOT my specialty (usually not even close), and it's also a quick hit to build rapport and that we are both docs, both out to help the pt.

I proceed to listen a bit to whatever the stumbling block is, then explain why I need what I need and how it will shorten the admit or a test will potentially cancel the surgery or etc.

Honestly, the only painful part is the timing of the call part (which is why insurances use them... hope doc won't do it). If you are throwing fists on the phone regularly, I think you're understanding it wrong... get a hobby like hunting, weightlifting, boxing, shooting range, archery, etc.

[Hawkeye225]

What does "simply trying to cash a check" mean?

Actually most at my place of work were still working clinical practice PT. All has to be board certified and were required to hold a license in at least one state.

For the clinical doc on the other end, the wait times and aggravation were painful. I feel ya there. Again, poor systems.

[MaxPower]

The most painful part is waiting on hold to be transferred to a doc who isn’t even in your specialty while you have to explain to them what the test is even for. The worst peer-to-peers are from an insurance company that rhymes with Bunited Mealthcare. They routinely deny tests just as a matter of practice. I tried not to be belligerent with them, but it’s difficult when the information they say they need (prior meds and treatment, other tests) are in the clinic notes they have that they clearly didn’t read. My bet is they just deny tests and then hope docs don’t call, and I’m guessing many don’t.

[Hawkeye225]

The most painful part is waiting on hold to be transferred to a doc who isn’t even in your specialty while you have to explain to them what the test is even for. The worst peer-to-peers are from an insurance company that rhymes with Bunited Mealthcare. They routinely deny tests just as a matter of practice. I tried not to be belligerent with them, but it’s difficult when the information they say they need (prior meds and treatment, other tests) are in the clinic notes they have that they clearly didn’t read. My bet is they just deny tests and then hope docs don’t call, and I’m guessing many don’t.

Your first sentence...absolutely correct. I would be beyond myself having to do that so I completely understand. Fortunately, we were all imaging and since I'm a radiologist, it was easy for me to help. Truthfully, I knew more than 98% of the people on the other end so it worked out great for all.

I worked for a different company, a large one. Not once was there any discussion of trying to deny requests. Seriously, not once. Also, no financial incentive whatsoever.

[VentAlarm]

I have enough things to worry about, so I rarely get in arguments. That’s not to say I don’t let people know what I think. I’m pretty comfortable looking someone in the eye and saying “yea, you’re wrong and I’m not going to waste any more of my time discussing it,” but I’m not going to raise my voice or get upset about it.

My wife has hinted that I may be someone on the spectrum….

[gap55u]

I agree with others who are driven crazy by having to call a number, to give a long case number to someone with a GED. Who asks a ton of stuff they already know and I do NOT need to give them the patient's insurance info or whatever. And then I get transferred to a nurse. who asks the same questions. Who transfers me to a doc. Who clearly has none of the prior information. So by the time I get to the doc, I'm grumpy. The most recent prior auth was like this and the guy was like "yeah, I see the info right here in your note, I don't know why this was denied." And another - they had me call, went through a long process - and then they said well, we don't actually deny studies under this person's insurance, we just wanted to let you know why we felt it wasn't indicated. That was so much better than leaving clinic on time!

I am now having my MA or front desk get the doc on the phone, then I take the call.

[Hawkeye225]

Agree completely gap....that is exactly what I meant regarding the system. Yes, have the MA, nurse, etc. call so that you won't have to leave medicine earlier than necessary. I knew that I couldn't solve this problem and that is the main reason (besides being corporate) that I decided to not move up the food chain.

[The White Coat Investor]

So glad I don't have to do any of that in the ED. I know I occasionally order a study for whatever reason that would be turned down I'm sure. More commonly, I get a patient sent in because their insurance is giving them the run around and the easiest way for them to get an abd CT or a brain MRI they really do need is for me to order it since I don't need a pre-auth to do it. And the insurance ends up paying 2 or 3 or 5 times what they would have had they just approved it.

[ACN]

P2p are awful. Typically a giant waste of time. My hand partner just had one the other day that a patient had two years of documented therapy, injections, bracing, standard imaging, and worsening symptoms.

Partner ordered MRI and got denied because hasn't done therapy within the last 6 weeks. I thought my partner was gonna climb through the phone and strangle someone. He's like do you really think another therapy session now is magically going to cure a patient that's had every conservative option? Yes, this new magical therapy is going to solve everything! He was livid.

It's so random. You get denials for standard imaging, then you get a new patient referral from a pcp for knee pain in a 14 yo with an MRI. Like, how'd a 14yo get approved for an MRI after twisting his knee in gym class and has a negative exam.

I'm getting more and more denials where insurance companies are saying things are experimental. Robotic knee replacement.. 14 years of data.. All of a sudden, experimental with one company.

[Hawkeye225]

ACN...couldn't agree more except the last paragraph, don't know about that issue.

[Bdoc]

As i was complaining to a colleague about it, he said he knew someone in medschool who was sent their by an insurance company. The insurance company paid for the medschool just to work for them afterwards. sounds sketchy AF

[redsand]

Nothing like 2 strangers getting in fight over no reason(my salary does not change weather i win p2p)

Why take the time to do the P2P if your employer doesn't pay you to spend time doing them? Do you have enough time otherwise to fit these in to your day?