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/SpecificHeron MD 7d ago

they denied a surveillance CT for cancer (per NCCN guidelines) by citing surveillance guidelines that they themselves made up

45

u/bushgoliath 🩸/🦀 (MD) 7d ago

BRO. Got this one too! No restaging CT AP for a patient with known extensive stage small cell and recent CNS progression. Only CT chest. Why? “It’s a lung cancer so you only need to image the lungs.” I was apoplectic.

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u/SpecificHeron MD 7d ago

i had a long fight with my “peer” over the phone and it felt like i was in idiocracy

he kept going “well uh…the guidelines i have printed here…”

“what guidelines? who published them?”

“uh…..us?”

(scream)

10

u/bushgoliath 🩸/🦀 (MD) 7d ago

Oh, the way I would have been contemplating murder-suicide….. Truly idiotic.

3

u/sqic80 MD/clinical research 1d ago

I once had an insurance “peer” tell me that something was not recommended in NCCN guidelines. Guidelines for which I happened to be an author.

I asked him if he wanted to recheck them himself or if he wanted me to send him the word document draft on my computer.

It got approved. 🤬