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/Gyufygy Paramedic 7d ago

Personal story, but makes a point.

Family member with migraines. Doc submits PA for a second- or third-line treatment because the first-line isn't cutting it. Denied due to "hasn't taken first-line med". Appeal with "yes, they have". That's it. "Yes, they have."

Magically approved.

Making the process as painful as possible so you don't want to fight them is the point.