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
Independence 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 1-800-645-3965 for Keystone 65 HMO members or
1-888-718-3333 for Personal Choice 65SM PPO
members.