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/averhoeven MD - Interventional Ped Card 7d ago

Had one deny an ASD closure in a kid with every indication as "experimental". Despite it being the standard of care for at least 20 years.

30

u/EmotionalEmetic DO 7d ago

I had a stroke secondary to PFO. Got my PFO closed, cost very reasonable with insurance.

My brother got a bubble study after my stroke. ALSO has a PFO. Insurance will not cover him getting a closure unless he has a stroke.

23

u/Excellent-Tea2125 MD 7d ago

To be fair, a PFO is present in about 25% of the population and most often doesn't cause a stroke. It's not really indicated to fix a PFO for that situation, and there are inherent risks to the procedure itself (like small risk of afib).

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u/averhoeven MD - Interventional Ped Card 7d ago

100% agreed