Ambetter doing bare minimum to reach out to doctor for Peer to Peer – help!

Hi y’all,

If you’re reading this you all know how it starts.

So my doctor prescribed me zepbound. Pharmacy required PA. PA was denied. Appeal sent alongside a Formal Letter of Necessity. Insurance schedules a Peer to Peer.

Now Ambetter states they will make 3 attempts to reach out to my busy doctor running his medical practice. They have called twice – each time in the middle of a patient appointment – leaving no message and no call-back number.

My provider’s office has faxed 8 PA’s and 8 appeals in the past 4 months and when I initially called Ambetter I was told they had no record of anything from my provider. So I was already furious by the time I had called them.

What can I do to make this peer to peer actually occur? I want them schedule a time with my doctor for them to call him. Or I want a scheduled time for my doctor to call them. Or I want them to leave a message with a call back number.

The third attempt for them to call is tomorrow. If it’s unsuccessful I’m going to call them again requesting another peer to peer while mentioning that I will be filing a complaint with the Texas Department of Insurance and consumer protection while threatening to get legal counsel (I have no plan on doing that and cannot afford to do that but hey, maybe threatening to get a lawyer involved might mean something?).

Does anyone have any advice or personal experience on how they made a peer to peer successfully happen?