A peer-to-peer review is a direct conversation between your treating physician and the plan’s medical director or physician reviewer. It is most useful for medical-necessity and prior-authorization denials, where a short doctor-to-doctor discussion can resolve a misunderstanding faster than a written appeal. As the patient, you can ask the plan to allow a peer-to-peer and ask your doctor’s office to schedule it. These requests often must be made within a short window after the denial, so act quickly and check the deadline and contact number on your denial letter. This guide gives you a letter to send the insurer plus a short note you can forward to your doctor’s office.
Before you write
Gather what both you and your doctor’s office will need:
- The denial letter or EOB with the denial reason and code.
- Your member ID, group number, and claim or authorization number.
- The date(s) of service and the date of the denial.
- Your treating physician’s name, office contact, and best times for a call.
- The plan’s peer-to-peer or utilization-review phone number if listed.
The letter
[Your full name]
[Your address]
[City, State ZIP]
[Phone] | [Email]
[Date]
[Insurance company - Utilization Review / Appeals Department]
[Address from your denial letter]
Re: Request for peer-to-peer review
Member: [Name] Member ID: [number] Group #: [number]
Claim/Authorization number: [number] Date(s) of service: [dates]
Denial date: [date] Denial reason/code: [as stated on the EOB]
To the Utilization Review / Appeals Department:
I am requesting a peer-to-peer review of the denial identified above. I ask that
the plan make its medical director or physician reviewer available to speak
directly with my treating physician about the medical necessity of the requested
care.
My treating physician is:
[Dr. name], [specialty]
[Office phone] | [Office fax / email]
Best times to reach the office: [days/times]
Please contact my physician's office to schedule this call as soon as possible,
and please confirm the deadline for requesting a peer-to-peer so that my right
to appeal is preserved. If a peer-to-peer cannot be arranged, please treat this
letter as my request to proceed with a formal appeal and tell me how to do so.
Enclosed in support:
- [Copy of the EOB / denial letter]
- [Letter of medical necessity from Dr. [name], if available]
Thank you for your prompt attention.
Sincerely,
[Your signature]
[Your printed name]
Short note to forward to your doctor’s office
To: [Doctor's office]
From: [Your name], patient DOB: [date] Member ID: [number]
My health plan denied [service/authorization] (claim/auth #[number]) on [date]
for [reason/code]. I have asked the plan to allow a peer-to-peer review and gave
them your office contact info. Could a provider please call the plan's medical
director to discuss medical necessity?
Plan peer-to-peer / utilization line: [phone from denial letter]
Reference: claim/authorization #[number], denial date [date]
Please let me know if you need anything from me. Thank you.
How to send it
Send the insurer letter through the plan’s utilization-review or appeals channel (phone, fax, or portal) and follow up in writing, since peer-to-peer windows are often short. Give your doctor’s office the short note and the plan’s phone number so they can schedule the call directly. Keep a dated copy of everything. A peer-to-peer does not always overturn a denial, so if it does not resolve the issue, file a formal internal appeal before your deadline.
Notes. A peer-to-peer review lets the treating physician speak directly with the plan’s medical director or physician reviewer; it is commonly offered for medical-necessity and prior-authorization denials and often must be requested within a short window after the denial, so the timing on your denial letter controls. The patient can request that the plan allow a peer-to-peer and ask the doctor’s office to schedule it, but the substantive discussion is between the two physicians. If a peer-to-peer does not resolve the denial, escalate with the medical-necessity appeal or the steps in the prior-authorization denial guide. This is general information, not legal or medical advice.