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Peer to Peer Review
I have been dreading the 5 year history for morbid obesity, because being off again/on again diets, one of the years notated in my PCP's report, I was 1 1/2 BMI points down.
So I asked my Pre-Certification Coordinator if it would be denied simply for that. Her statement was that possibly, but if that happened the surgeon would just do a Peer to Peer Review.
I have heard several people, here, speak of this and I was just curious as to whether anyone had been denied once their surgeon participated in a review?
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Re: Peer to Peer Review
What is your BMI? Do you have co-morbidities?
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Re: Peer to Peer Review
BMI was 37, until I had to lose the 10% required by insurance and I have 2 co-morbities