Peer-to-Peer Denied, Now What?

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Hi All. My health insurance just recently denied my jaw surgery prior authorization. My oral surgeon then did the peer-to-peer evaluation, and that too was denied. I was told by my surgeons office that they don’t often see this much pushback. My insurance company is saying it is not medically necessary.

I was told the next step would be for me to submit an appeal myself. I am awaiting a call from my surgeons office to give me more details but am wondering if anyone has any advice on how to get started or what to expect?

I’m a bit nervous on what I will have to do – I’m guessing write a letter claiming why I find it medically necessary? Perhaps I can submit letters from my orthodontist and speech pathologist to help back me up.

I’m really bummed to hear my claim was denied. Trying to stay positive but I keep thinking “if they’re not listening to the chief oral surgeon, then why would they listen to me?”

Thanks all.

Edit: just to be clear, I have not had the surgery, I was hoping to get approved and schedule the surgery for early next year.

submitted by /u/sleepyburritocat
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Hi All. My health insurance just recently denied my jaw surgery prior authorization. My oral surgeon then did the peer-to-peer evaluation, and that too was denied. I was told by my surgeons office that they don’t often see this much pushback. My insurance company is saying it is not medically necessary. I was told the next step would be for me to submit an appeal myself. I am awaiting a call from my surgeons office to give me more details but am wondering if anyone has any advice on how to get started or what to expect? I’m a bit nervous on what I will have to do – I’m guessing write a letter claiming why I find it medically necessary? Perhaps I can submit letters from my orthodontist and speech pathologist to help back me up. I’m really bummed to hear my claim was denied. Trying to stay positive but I keep thinking “if they’re not listening to the chief oral surgeon, then why would they listen to me?” Thanks all. Edit: just to be clear, I have not had the surgery, I was hoping to get approved and schedule the surgery for early next year.
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