Disclaimer: This content is educational and based on 20+ years of case management experience. It is not medical advice, clinical guidance, or legal counsel. Consult with qualified healthcare providers, case managers, and legal professionals for decisions affecting your care.
Remember that Tell-Tale Voicemail that inspired me to write The P2P Playbookâ„¢? That was just the warm-up act. The real breakthrough came courtesy of some luck, Little League Soccer and a medical director I'll call "Tom."
The Setup
Tom had caught my attention for a couple of years. He was a community leader during the day, but also known for his strict approach to medical denials. His rejection rate for inpatient neuro rehab was 100%. My attending physician described him as the typical utilization review type: friendly on the phone, always using the right insurance terms, but with little understanding of neurorehabilitation and never straying from the rules. She called him a denial Sith Lord.
Until I did a little digging.
The Soccer Connection âš½
Tom also coached a Little League soccer team in Austin set to play against my granddaughter's squad the next weekend.
My wife and I drove to Austin for the game.
Game Day
On game day, I chatted with Tom on the sidelines. I complimented his team's defense.
He asked which child was mine, and I pointed out my granddaughter. He was complimentary, then oddly asked to visit after the game. Long story short: he recruited her to play on his team the following season.
Tuesday morning P2P call: a completely different tone. The attending was in disbelief. The same clinical facts and documentation, yet a completely different outcome.
The Uncomfortable Algorithm
A personal connection didn't just influence the decision. It changed the whole conversation. The patient, the medical need, and the protocols were all the same. But with a different relationship, the outcome changed.
That moment on the soccer field made something clear that the voicemail pattern had only suggested. P2P calls aren't just clinical reviews in quiet conference rooms. They're real conversations between people who coach Little League and are more likely to approve cases for colleagues they know.
The Playbook Writes Itself
This wasn't about cheating the system or putting patient care at risk. The point is that even evidence-based medicine is handled by people with their own lives, relationships, and hidden biases. Knowing this can help you handle these situations better.
People like Tom are human and often act in predictable ways. If you understand these human factors, you can work through these systems more effectively.
The P2P Playbookâ„¢ is that story, told straight. If it reads like satire, that's the system's joke, not mine. The fact that you're not sure is exactly the problem.
The P2P Playbookâ„¢ is a work of satire for entertainment purposes only. Any resemblance to actual insurance company practices, living medical directors, or successful manipulation tactics is purely coincidental. These opinions are mine, not my employers. Shaped by two decades of care coordination, grief, absurdity, and a drawer full of denied continued stay requests for inpatient rehab.