Hundreds of physicians across the nation have taken to Twitter to share their thoughts on a simple question: What is the insurance denial in your specialty that frustrates you and your patients the most?
The question has attracted more than 800 responses and 830,000 views as of April 21. It was posed April 19 by William Flanary, MD, a widely known ophthalmologist who practices in Oregon City, Ore., and has garnered millions of followers across social media for his medical satire content.
With nearly 1 in 5 health insurance claims facing denial each year, here's what physicians say are some of the most frustrating denials they've experienced:
J. Milo Sewards, MD. Orthopedic surgeon at Temple University's Department of Intercollegiate Athletics (Philadelphia): A recent denial of admission and fixation for a patient's fractured tibia caused by a gunshot. The denial stated the patient should be expected to recover in one to three days.
Amit Momaya, MD. Orthopedic surgeon at the University of Alabama (Birmingham): I once got denied by insurance for an ACL reconstruction on an 18-year-old soccer athlete because they said we hadn’t tried acupuncture.
Neil Floch, MD. Bariatric surgeon, director of bariatric surgery at Greenwich Hospital (Connecticut): The denial of coverage for both obesity treatment medications and for bariatric surgery. Somehow the medical evidence that supports the only long term and most successful treatments for #obesity is ignored and patients are allowed to be discriminated against.
Amy Houtrow, MD, PhD. Vice-chair for pediatric rehabilitation at the University of Pittsburgh and medical director of the Rehabilitation Institute at Children's Hospital of Pittsburgh (Pennsylvania): Wheelchairs. I once had an insurance company deny just the wheels. 'A wheelchair without wheels is just a really expensive chair and defeats the purpose of a wheelchair,' I explained on peer-to-peer.
Woodson Smelser, MD. Urologic oncologist at Washington University School of Medicine (St. Louis): Denial of NCCN guideline-indicated CT scans for testis cancer surveillance.
Courtney White, MD. Neurologist at Jefferson Health (Philadelphia): When a previously covered treatment is suddenly no longer covered without warning — particularly with headache and migraine medications, she noted.
Wesley Ely, MD. Sub-specialist in pulmonary and critical care medicine at Vanderbilt University Medical Center (Nashville, Tenn.): Denial of #LongCOVID cognitive disability. So real and so misunderstood.
James Wiginton, DO. Neurosurgeon affiliated with Riverside University Health System-Medical Center (Moreno Valley, Calif.): Brain tumor removal.
David Steensma, MD. Oncologist and professor at the Mayo Clinic (Rochester, Minn.): Antiemetics for patients receiving emetogenic chemotherapy, targeted oncology medications for patients with the specific biomarker for which that medication is designed, and staging and surveillance scans following [National Comprehensive Cancer Network] guidelines. Those should all be automatic but they aren’t.
Mark Patterson, PhD, MD. Primary care and pediatrics, Carilion Clinic (Roanoke, Va.): Being forced to change effective ADHD medications because of a formulary change. The kids have to fail for two months before being able to reinstate the prior med.