Peer-to-peer call brief (for your clinician)
A one-page set of notes in your clinician's voice for a call with the plan's reviewing doctor: the three points to make, the questions to ask and what to record. Every clinical statement is a blank for the clinician to complete.
- Private: nothing leaves this tab
- A template, not legal advice
When to use this, and what it is not
When to use this. How to hand this to the office: print it or save it with the blanks showing, clip your denial letter to it, and ask the clinician to fill in every clinical blank from your chart, edit it in their own words, and sign it. You fill in only the plan details. The wording is a starting point for the clinician, who decides what is accurate for you. A peer-to-peer call is a conversation between your clinician and the plan's reviewing doctor. Plans set their own process for these calls, so ask the plan whether it offers one and by when you must ask. A call does not replace an appeal, so keep your appeal deadline in view.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the letter
Your letter
[Your name] [Your address]
13 November 2026
[Name and address of the plan's medical reviewer]
Re: Peer-to-peer call brief (for your clinician) Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To the reviewer:
Peer-to-peer call brief for [The patient's full name], member ID [Member ID], [Name of the health plan], case reference [The plan's case or reference number].
I am [The clinician's name], [The clinician's credentials]. I treat [The patient's full name] as a specialist in [The clinician's specialty]. I am calling about the decision of [Date on the denial notice] to deny [The care or drug that was denied]. The stated reason is: [The reason the denial gives]
My three points: 1. Diagnosis and current status: [Diagnosis]. [Current clinical status] 2. What has been tried and what happened: [Treatments tried and the results] 3. Why this service, and what happens without it: [Why the denied service is needed] [What is likely to happen without it]
Evidence I will cite: [Evidence to cite on the call]
Questions I will ask the reviewer: - What is your name, specialty and licence? - Which criterion or guideline did the plan apply, which version, and may I have a copy? - Which specific requirement do you say the record does not meet? - Can you reverse the decision on this call? If not, who can, and by when? - When and how will the plan confirm the result in writing?
What I will write down: the date and time of the call, the reviewer's name, the outcome, and any reference number.
After the call: I will ask the plan to confirm the outcome in writing and tell [The patient's full name] the same day so that the appeal deadline is not missed.
Enclosures: 1. Copy of the denial letter 2. Chart notes and test results for the call
Sincerely, [Your name]
Before you send it
This is a working document for the call, not a letter to mail. Ask the plan for its peer-to-peer line or process; the number is often on the denial notice, and the member services number on the card can tell you. Write down the date you asked and the person's name. To prove the call happened, record the date, time, reviewer's name and reference number, and ask the plan to confirm the outcome in writing.
What to enclose
- Copy of the denial letter
- Chart notes and test results for the call
What happens next
- You: ask the plan today whether it offers a peer-to-peer call and by when it must be requested. Write down the answer and the name of the person you spoke to.
- Your clinician's office: schedules the call, and the clinician completes the blanks first. Give the office the denial letter and the case reference number.
- Your clinician: makes the call, records the reviewer's name, the outcome and any reference number, and tells you the same day.
- You: ask the plan to confirm the outcome in writing. If the denial stands, appeal. Your appeal deadline depends on your coverage and is printed on your denial notice. For most job-based and individual plans it is at least 180 days after you receive the notice. Medicare, Medicaid, TRICARE, Veterans Affairs and federal employee plans have different deadlines, often shorter, and they are on your notice. Check the date on your notice, which controls.