For Medicare Advantage members, any request to change an initial adverse plan decision must be handled through the appeals
process — not through peer-to-peer discussion. For a pre-service decision, a provider may request a peer-to-peer discussion as part of an optional, informal process designed to encourage dialogue between the requesting provider and the AmeriHealth medical directors. However, this process cannot be used to request a reconsideration of the initial adverse decision.

If you disagree with an adverse preapproval decision and wish it to be reconsidered, you must request an appeal by contacting Medicare member services at 1-866-569-5190 for AmeriHealth 65 HMO members.