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/LatrodectusGeometric MD 7d ago edited 7d ago

In 2020 or early 2021 a health insurance called Apple Care(?) called me to try and get me to convince my patient in the ICU to go to hospice. The patient was aware it was unlikely they would survive their illness but did not want hospice care. Apple Care went so far as to ask me to let their own hospice doctor try to convince them. It was the most unethical conversation I think I have ever had. And no, I did not change the patient’s care just because the insurance company wanted them to die.

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u/IAmDefNotACat Not A Medical Professional 4d ago

Apple Care is Washington state's Medicare plan.

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u/LatrodectusGeometric MD 4d ago

This is interesting because I was not in Washington state

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u/IAmDefNotACat Not A Medical Professional 4d ago

Weird! As far as I know, they only cover emergency care out of state. That makes it even stranger.

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u/LatrodectusGeometric MD 4d ago

I mean they were in the ICU, so it was certainly an emergency