Posted on 08/08/2025 7:05:00 AM PDT by Red Badger
In January, Dr. Elisabeth Potter said she was midway through performing a breast reconstruction surgery when a call from a representative from UnitedHealthcare came into the operating room. The health insurance company wanted to talk about the patient on the table.
“I got a phone call into the operating room saying that UnitedHealthcare wanted to talk to me and that they wanted to talk to me now,” Potter, a plastic surgeon, told NBC News. Potter posted a video on TikTok recounting the call that’s reached nearly 6 million views.
During the call she said the UnitedHealthcare representative wanted more information on why the patient needed an overnight hospital stay, even though the surgery itself had already been approved.
“The person on the phone asked for her diagnosis, for the patient who was under anesthesia on the table,” she said. “That call was just this wake-up call. If they can ring me in the operating room, not for something urgent, just for that, and to ask me to justify her staying overnight … we have lost our way.”
Potter acknowledged that it was her decision to step out of the surgery to take the call. But “in 2025 with insurance,” she said, “when they say ‘jump,’ I say, ‘how high?’”
A spokesperson for UnitedHealthcare said the company “did not ask — nor would it ever expect — a physician to interrupt patient care to return a phone call about a notification error or any other insurance matter.”
Potter said UnitedHealthcare denied coverage for the hospital stay. The insurance spokesperson said the stay was approved but there was an error with a separate request.
Now, Potter said she believes UnitedHealthcare is retaliating against her because of her social media posts, putting her at risk of bankruptcy.
The health insurance company, she said, has not allowed her clinic — the RedBud Surgery Center in Austin, Texas — to join their in-network list of providers. She started the clinic in April 2024. Potter herself remains in network, meaning she can perform surgeries in a hospital, but because the facility is out of network, she can’t operate there.
(In network means a health insurer has a contract with a health care provider, agreeing to pay for services at preset rates. Out of network means there’s no contract, so the insurer could pay less or not at all. Patients are far less likely to see out-of-network doctors because, without insurance paying, the patients must cover the entire cost.)
Without being able to accept UnitedHealthcare patients in network, Potter said she likely won’t be able to stay in business. While she’s in talks to join other insurers’ networks, UnitedHealthcare is the second biggest player in the market, according to the Texas Department of Insurance.
Potter said she’s currently $5 million in debt and her husband had to cash out his 401(K) to help them stay afloat.
If you are dealing with bills that seem to be out of line or a denial of coverage, care or repairs, whether for health, home or auto, please email us at Costofdenial@nbcuni.com.
“My goal has always been, how do I make this work? I’m a problem-solver,” she said. “The fact that they hold the strings in that way, that they’re able to control the economics of the practice of medicine down to the facility that I’m operating in, it seems just arbitrary and also somewhat cruel.”
The UnitedHealthcare spokesperson said the company informed Potter that its network was closed to new centers in October 2024, well before she began posting the social media videos. The spokesperson also said there was already a sufficient number of surgery centers in the area by Potter’s clinic.
The spokesperson added that Potter’s consultant continued to reach out to the company after October, but “there were no ongoing negotiations.”
Potter said that UnitedHealthcare remained in contact with her consultant until January, around the time she posted the viral video. “I don’t know how United defines negotiations, but there were ongoing communications pushing for me to be in network,” she said.
Ongoing tensions
Potter’s dispute, experts say, is one example of ongoing tension between insurers and health care providers.
Dr. Adam Gaffney, a critical care physician and assistant professor of medicine at Harvard Medical School, said that dealing with health insurance companies is “part and parcel” of the life of most doctors in the U.S.
Gaffney, who did not speak specifically about Potter’s case but the industry in general, said that part of health insurers’ jobs is to prevent unnecessary care as a way to counter the exorbitant cost of health care in the U.S., from pricey drugs to expensive hospital stays.
But for many doctors, that means constantly dealing with prior authorizations, claim denials and other barriers to care that patients need — sometimes even after the care has already been given, he said. That applies even when providers are in network: A study from the health policy research group KFF found that in 2021 insurers denied an average of 17% of claims, even when patients received care from in-network doctors.
“I think this is the wrong way to do it,” Gaffney said. “There’s no question that fighting with insurance companies is not why people signed up to be doctors.“
The difficulties patients and providers face with health insurance companies drew renewed attention last year after the fatal shooting of Brian Thompson, the CEO of UnitedHealthcare, in New York City.
UnitedHealth Group — the parent company of UnitedHealthcare — has been under intense scrutiny. Following the death of Thompson last year, the company disclosed in a regulatory filing in July that it’s facing a civil and criminal investigation from the Justice Department after reports of a probe related to its Medicare billing practices. The company is also being investigated for potential antitrust violations, The Wall Street Journal reported, citing people familiar with the matter. The company told WSJ in a statement that it stands “by the integrity of our Medicare Advantage program.”
In May, Andrew Witty, the CEO of UnitedHealth Group, suddenly stepped down, citing “personal reasons.”
A New York Times report published in July said the health insurer has sought to silence journalists, filmmakers and health care professionals who criticize them online. The Times’ report cites a number of sources by name, including Potter. In a statement, a spokesperson for the company told the Times, “The truth matters, and there’s a big difference between ‘criticism’ and irresponsibly omitting facts and context.”
“I think more and more people are coming to understand that insurance companies are doing a good deal of the rationing that is a part of the American health care system,” said Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center in New York City. “I think that the system that we have, private for-profit entities telling us what our medical care should be, is ridiculously immoral.”
“It’s going to take serious government intervention,” Caplan added. “If we don’t do it, we’re still going to wind up with all these disputes as insurers try to contain costs.”
Keeping the lights on
Potter agreed that the broader health care system needs fixing, adding that she feels “strongly” that health insurance is a good thing as it makes care more affordable for patients.
Potter said she left hospital work and opened her own clinic in April 2024 after realizing she could provide the same services at a lower cost to both patients and insurance companies — while earning more herself.
“I’m just trying to do surgeries that women need and like in the best way possible,” she said.
She said she took out $3.5 million in personal loans to open the clinic, even jumping through hoops to get it certified so they could legally accept private insurance and Medicaid patients, something that not all surgery centers are able to do.
“It’s such a scam,” she said. “You have to pass all the health hurdles when you build a surgery center to make sure it’s a safe place for patients. And then, as someone who wants to provide care, then you have to approach insurance companies.”
Because of insurance issues, she said she’s currently not taking a salary and may only have a few months left to stay in business.
“All I want is for the patients who are medically appropriate to be at RedBud Surgery Center to have their surgeries here, same care for patients, and it helps keep my doors open and the lights on, and it’s less expensive for the system.”
Obama giggles on the toilet ,in the shower, when he gets up, as he eats breakfast, when he plays golf, the guy is giddy with delight over how “ Healthcare for everyone” has become a fiscal nightmare for the average white American. Giggidy giggidy, giggidy!! Giggles
The Giggler-In-Chief................
“That call was just this wake-up call. If they can ring me in the operating room, not for something urgent, just for that, and to ask me to justify her staying overnight … we have lost our way.”
She takes a call while operating? She cannot be reached if she doesn’t want to be reached. I can’t imagine my surgeon taking a call.
There is mention of her social media posts. Some have a good picture here. A social media darling who will take a call on her phone during surgery whining about not having her way.
If she was any good she could have a practice not reliant on insurance. The best plastic surgeons are usually out of network if they are in any network at all.
Thanks. I stopped reading about then. It was too boring.
I almost missed that as well.
My understanding is that if you are on traditional Medicare with a supplement policy, if Medicare pays, the supplement pays too. They don’t get to challenge that.
While it is true that many doctors are in Advantage plan networks and take traditional Medicare as well, there are many more that take Medicare but are not in Advantage plans. These are usually the doctors you want to have if you need care that requires a high level of competence.
I opted for traditional Medicare when I turned 65. No regrets. I pay my $250 deductible, and the rest is taken care of by the gummit and the supplement company. I had Mohs on my nose last week, and I am going in for cataract surgery the next 2 weeks. No fighting bureaucrats for authorizations. It costs me more every month, and I don’t get $900 of funny money to spend at some website, but I do get the care I want when I want it.
“Potter said she left hospital work and opened her own clinic in April 2024 after realizing she could provide the same services at a lower cost to both patients and insurance companies — while earning more herself.”
“She said she took out $3.5 million in personal loans to open the clinic”
“then you have to approach insurance companies.”
She did things in the wrong order.
“Why shouldn’t a doctor providing medical care make a living from it?”
A doctor’s salary would be paid as a business cost.
“There is nothing wrong with for profit medical care.”
I completely disagree. The well being of the patient should be the primary concern, not the share price or earnings per share.
In our recent hospitalization the case worker came in to review our insurance / expected costs. I pay for traditional medicare and Part G supplement. I also paid in to the system handsomely during my working years. The case worker said we would have very little out of pocket expense. She was right, about $400, less than 1% of the billed cost.
I asked her what happens with Advantage. Short answer, lots of unexpected bills for out of network. We live near the state line and to stay in network one must travel over 100 miles for medical care comparable to what can be had across the state line just 25 miles away.
I know the country is broke and that the medicare, medicade and SSI are going broke. I can’t do a thing about any of it. I paid in a lot of money to these systems and I will take all I can get for as long as I can get it. NO remorse at all.
If they want to change the programs and keep me whole that is fine with me as well if there is a reasonable and affordable alternative.
Medical “care” in this country is busted with too many hogs at the trough lapping up 17% and increasing of the economy. It has gone on much longer than I ever expected without reform. Medical costs are a problem on par with illegals but it is not even on the radar screen for reform. I wonder why? Could it be that they are paid well and pay their friends in gooberment just as well or better?
There is the in-network/out-of-network issue.
By channeling insured to a subset of providers, the insurer can get better pricing.
However, there are limits to that, hospitals that provide emergency service are better able to insist on being in-network providers even if their charges are higher as some insureds are going to need hospital emergency service.
What I would do is to break most hospitals into two operations as separate as possible. The breakups might start at the largest operations and work downward.
An ambulance might turn right or left depending on your insurance coverage.
The EMTALA mandate should be cut back. Only one visit in any 12-month period per facility, with a $200 per visit limit waiver. The EMTALA hospital should be able to collect as with student loans. EMTALA providers who are not hospitals should be able to collect to the scope of the IRS, but second to the IRS.
As for out-of-network, the insurer should have to pay what it pays to its lowest cost provider for the item, less 10% once the insured pays the policy co-pay/co-insurance, with the balance being the patient responsibility.
“Could it be that they are paid well and pay their friends in gooberment just as well or better?”
The local and state government employees typically have wonderful coverage, far better than that of members of Congress.
What might be done is to make employer health care contributions taxable if the employer coverage costs more than 90% of the PPACA base silver plan premium amount for the ratings area. The PPACA had a luxury plan tax, but it did not adjust for local conditions and was dropped.
“If she was any good she could have a practice not reliant on insurance”
Breast reconstruction is typically a mandated benefit.
Patients expect insurers to pay for most of the cost.
“The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.
“If WHCRA applies to you and you are receiving benefits in connection with a mastectomy and you elect breast reconstruction, coverage must be provided for:
“All stages of reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of all stages of the mastectomy, including lymphedema.”
“WHCRA requires group health plans and health insurance companies (including HMOs), to notify individuals regarding coverage required under the law. Notice about the availability of these mastectomy-related benefits must be given:
To participants and beneficiaries of a group health plan at the time of enrollment, and to policyholders at the time an individual health insurance policy is issued; and
Annually to group health plan participants and beneficiaries, and to policyholders of individual policies.”
https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/whcra_factsheet
NOTE: The page is probably outdated. The PPACA is based on “medically necessary”.
Insurance companies are evil.
If she was any good she could have a practice not reliant on insurance
So, only patients who can pay out of pocket deserve a surgeon who is “any good”?
Read the rest of my post. The profit should be to those directly providing the care. Not to some investment group that bought up a string of hospitals.
I have the same Medicare setup. One of the pluses is that we have much better access to medical care here than they have in other countries. I cannot complain about wait times or any of that.
The real problem with medical care is that there is so much that can be done now. Take leukemia. Back in the 60’s if you were diagnosed with that, it was all over. Go home and get your affairs in order and they’ll give you morphine if anything hurts. Today, it is treatable, but with long, drawn out, complicated, and expensive procedures.
Not too long ago, a woman on dialysis got an engineered pig kidney made especially for her. It actually lasted for 2 months before they started tinkering with her medication and then it quit working. That is very promising, very impressive, and undoubtedly very expensive. What is going to happen if this treatment comes online? Every kidney patient is going to want a bespoke pig kidney, and they are going to want it now. Who is going to pay for this? And this is just the tip of the iceberg.
I suppose we could set a cap on how much of the economy can be devoted to medical care, but I don’t know how that would be administered.
There is a lot of soul searching that going to need to be done.
“So, only patients who can pay out of pocket deserve a surgeon who is “any good”?”
Let’s say that “any good” means the top 10%. How do you propose we ration that?
I did read the rest of your comment and wholeheartedly agree, that’s why I didn’t mention it. My bad. 😁
I think of medical care as a service and of course those providing the care need to make a living. If they became doctors to be rich, they’re in the wrong profession, IMHO.
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