A family member is experiencing new symptoms that were the precursor to discovering their cancer originally. Unfortunately at diagnosis, they were already stage 4.

The oncologist ordered a specific scan, the insurance company denied it, and then required a "peer to peer" meeting with the doctor. They forced the doctor's hand to accept a different type of scan, which at an earlier point of treatment had returned a false negative for us. And the process is also causing, and has caused in the past, delays to treatment in an extremely time sensitive situation.

What can I possibly do about this peer to peer theater? There is absolutely no way the insurance companies' "peer" knows the latest details about the ever evolving treatment the oncologist is using. And this "peer" certainly knows nothing about my family member's specifics when it comes to their treatment history.

How is this stuff even legal? I googled around and found this disturbingly similar situation blogged by a Dr. Rick Boulay in 2017: https://www.kevinmd.com/blog/2017/09/dear-insurance-doctor-not-peer.html

Then I stumbled upon an old New York Times article that quoted him, about how doctors are sometimes lying to insurance agencies in order to get the treatment their patients desperately need: https://www.nytimes.com/2018/06/21/well/the-strategic-lies-of-oncologists.html (archive: https://archive.md/5lfkU#selection-505.42-505.45)

What the hell is going on? This is absolute madness.