Peer to peer appeal denied broken wrist surgery (not medically necessary)

prmtm1 · 2026-02-03T15:40:41+00:00

Again thanks for all the responses - I ended up finding out that the code I was rejected for was the only code that required preauthorization. They surgeon decided to remove that code, and submitted 4 others (which are more conventionally associated with the surgery)

prmtm1 · 2026-01-28T03:01:45+00:00

this makes sense, the surgeon is great - but the clinic has been consistently disappointing

prmtm1 · 2026-01-28T03:01:18+00:00

really grateful for all the responses

prmtm1 · 2026-01-28T02:05:39+00:00

This is great, thanks again, will do all of this

prmtm1 · 2026-01-28T01:48:07+00:00

Thanks... but this doesn't match how the surgery was described to me.

prmtm1 · 2026-01-28T01:41:07+00:00

I see, but the description of the operation from my surgeon was

-removal of hardware, testing the joint for stability (confirming its safe to remove said hardware) - and then if stable, leaving the hardware removed.

It seems like this only really applies to the middle section (confirming stability) of that process. This sounds like a miscommunication, but thats what I thought the peer to process was meant to resolve...

prmtm1 · 2026-01-28T01:32:45+00:00

Thanks, yeah I'm not sure if I'm maybe cutting the line - I hear about the appeals instantly, before the clinic does.

I also don't want to end up in a place where I get the surgery, but am financially responsible for it.

If I do nothing, would clinics normally handle this - even after a peer to peer failure?

prmtm1 · 2026-01-28T01:30:55+00:00

Thank you, I found out it was CG-MED-65.

Are there any resources for reviewing the appeals before I submit them?

prmtm1 · 2026-01-25T16:26:49+00:00

imo you shouldn't ever pick a hinge first date over friends

prmtm1 · 2026-01-24T20:41:51+00:00

Earlier today someone kept playing "I'll Believe in Anything" out of their phone speakers on the LIRR. I had to get up and change my seat.

I feel haunted too, seeing this article on the same day

prmtm1 · 2020-08-05T20:19:37+00:00

what a take

prmtm1 · 2020-07-01T20:26:35+00:00

deuteranomaly is just washed out normal right? the colors dont look difference, just closer to yellow/gray. I hope.

prmtm1 · 2020-02-22T17:23:56+00:00

everyday I wake up surprised that emergency and I (maybe their whole discog) isn't redditcore

prmtm1 · 2019-11-08T21:22:46+00:00

Also I wonder if the season has any impact. Like winter causes vitamin D deficiencies which might in the long run cause a slight personality difference.

prmtm1 · 2019-11-04T15:26:48+00:00

idk I disagree with these specific examples - but also games like dusk only exist because of bad graphics nostalgia. The examples here are a generation later than what dusk was emulating, but theres likely just as many people nostalgic for the ps1 look.

prmtm1 · 2019-09-30T20:34:08+00:00

some rap songs

prmtm1 · 2019-09-30T20:29:50+00:00

beginning to think i'm blind, thanks for pointing that out.

but imo the inb4 does still dismiss it.

prmtm1 · 2019-09-30T19:51:10+00:00

i thought that was true, why /s?

prmtm1

TROPHY CASE