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.
