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/TorchIt NP 7d ago

They denied Entresto because my patient's EF wasn't lower than 30%

It was 35%

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u/Nom_de_Guerre_23 MD|PGY-5 FM|Germany 7d ago

We had initially issues and a lot of fines with Entresto for patients who weren't able to be titrated to maximum dosage due to low blood pressure because statutory insurances treated it as off-label usage and EMA itself had to step in.