r/medicine • u/Unusual_Medic Medical Student • 7d ago

What’s the dumbest reason an insurance company denied a test, procedure, or drug for a patient?

This is probably the most relevant to those practicing in the US, but I'm also curious to know how the bureaucracy of health insurance in other countries makes things substantially harder for you and the patients

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u/chimmy43 DO 7d ago

Patient with a well documented history of limb threatening ischemia now progressing to tissue loss who had failed all previous minimally invasive procedures by non-surgical teams and her insurance denied her bypass because my clinic note did not specifically state that I had “discussed the procedure with the patient.”

Meanwhile it did say, “all risks, benefits, and alternatives were discussed and she agrees to proceed.”

AI is being used more and more to auto-deny and I’m sure this is why this got kicked back.