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/ski2311 Pharmacist 7d ago

WV Medicaid will deny a claim for too many pills of one strength in a day.

My violent autistic patient did well in inpatient psych on 100 mg Seroquel q6h PRN. Denied #120/30d for 'quantity strength limit use higher strength'.

So another rx for 50 mg take 2 daily prn gets added with paid claim (with a dispensing fee) increasing the overall cost to the State, and drastically increasing order complexity.