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.”
Agree spouse and I have had Medicare and pay for supplements every month for years. People at church ask me “Why are you paying for insurance every month? We have Advantage for free.”
I admit I have asked myself that question several times but spouse says you get what pay for.
Not everything we can do is something we should do but who decides?
We are not the only country that can treat lukemia or or other such things now we are only the most expensive place on the planet to get such care. That is the problem. We seem to have too many hogs at the trough and too much greed. The system is free to charge what the traffic will bear and does.
My brother-in-law, who is now deceased, was an Oncologist in a specialty group here in S.E. Michigan.
He was responsible for purchasing all the chemo therapy drugs he used in his practice. In his last couple of years, he had to drop out of the private practice and become a staff oncologist for the hospital group they worked out of.
The reason he had to drop out was because medicare and medicaid, which many of his patients were insured with, would not reimburse him for the total costs to him for the therapy drugs he had to administer.
Ironically enough, the same drugs could have been purchased thru a Canadian distributor at a fraction of the cost........
bttt
That's the job of hers and their attorneys......
We, the US taxpayer, have been Big Pharma’s bitch for waaaaay too long!...........
If you can identify anyone who can be fired without affecting the quality or timeliness of healthcare, then I am in favor of getting rid of them. But I am not sure how much of a dent you can make that way. Our standards are very high. The last few times I visited a hospital, the people were in private rooms. That seems to be the norm now. In a lot of places you are on a ward with a bunch of other people. There has to be a cost to that. In Canada, you can wait a very long time for some procedures. If someone needs something right now and they have no capacity, they send them to - guess where? The United States. We are literally the relief valve for their system. If we go their way, who is going to pick up our slack?
At least we are not yet in the same boat as the UK. People who have been waiting in line forever for some procedure are being pushed back even further to make room in front of them for illegal immigrants.
There were legions of people in the ward we were in and at any one time it looked like most of them were out in the halls talking. That does not mention the other legions of people in mandated medical records that seem to become property with ring fences around them, they sure are not shared.
I don’t think it would take long to identify redundancy but that is not the subject. The subject is excessive charges when the opportunity arises evidenced by huge apparent differences from one area to another.
Our medical system just costs too much on a global comparative scale.
I remember the days of wards and double rooms. They weren’t that bad when some good sense was made of parings. In unusual or very bad conditions single rooms were indicated and used. They were not standard though.
How many of these nations have health care that is much worse or less capable than ours? We don’t just spend more, we spend a LOT more.
United States| 12,555
Switzerland | 8,049
Germany| 8,011
Austria | 7,275
Netherlands | 6,729
Sweden | 6,438
Canada | 6,319
France | 6,630
Australia | 6,372
Japan | 5,251
In terms of life expectancy which seems to be a good measure of bang for the buck we don’t rank in the top 46 by life expectancy which does not vary by a whole lot but suggest some other measure if you do not like that one. Still, the point remains that the US spends a LOT more than other countries but does not appear to get a lot in return others don’t have for a lot less money.
https://www.worldometers.info/demographics/life-expectancy/
We also spend more per student on education than all but three OECD nations. Just a quick review shows we don’t get much bang for the buck there either.
https://www.statista.com/statistics/238733/expenditure-on-education-by-country/
There are also 20 countries that outscore US in overall PISA scores.
https://worldpopulationreview.com/country-rankings/pisa-scores-by-country
Try reading this:
https://market-ticker.org/akcs-www?post=253727
Karl Denninger has been on a tear recently about how medical costs have gone from 5% of GDP up to 20%, and how that will BANKRUPT the country.
Incidentally, he has an IQ of 187 and very little tolerance for BS. Salty language at the site.
that kind of call from any health plan would not happen, all that information is HANDLED IN THE PRE APPROVEL PROCEESS, SOUND LIKE EITHER A SCAM OR AN OVERALY OFFICOUS NURS REVIEWER.. never in 30 yrs of working in all aspects of the medical claims world have i heard of this happening. I am calling BS on this doc. plus why would a dr take to tic tock..
as for not allowing her clinic to become in-network has to do with her credentialing and billing practices i would guess
NOPE all the major health insurance companies had lobbiets on capital hill flogging Ocare. they all wanted a slice of the pie, the company i worked at that time a medicare health plan had the ceo in DC to lobby.. why dont know.
Granted United is the worst of the worst but this is the kind of BS which will guarantee single payer.
Granted United is the worst of the worst but this is the kind of BS which will guarantee single payer.
All part of the plan, why do you think nobody read the ObamaCare bill before they voted on it? They didn’t care. It’s just a means to an end.
different regions in each state make pricing different, larger cities have higher bills small cities/rual areas have different rates. the feds do the same with medicare payments
thank you for that Owen.. the hate is just so misplaced..
No business could survive such a drain. Too bad for us it is not our only similar drain.
Thanks for the link.
How is it you “deserve” a good surgeon? If you don’t pay for good healthcare who do you believe should pay it for you?
Do you deserve a good surgeon or the best?
OFFICE STAFF HANDLE ALL PRE AUTHURATIONS, IF HER STAFF SCREWED UP THEN THE STAFF IN THE OFFICE SHOULD HAVE HANDLED IT, AND NOT CALL THE DR..
this smells bad for the dr and her staff.
There is certainly a problem with the “list prices” vs what insurance companies pay. Someone without insurance should not be charged $10,000 for something an insurance company has negotiated down to $100. In Trump’s first term, they tried to get hospitals to disclose their prices, which I believe the hospitals are simply ignoring.
There is also an issue with legal expenses. What is the malpractice situation in these other countries? And the issue of who pays for deadbeats. People get treated at some level even if they do not pay. And they usually use the emergency room as their PCP, which is the most costly way to go. Also, we have to consider the quality of the data we are working from. A lot of this comes from organizations whose goal is to have the gummit running the entire system top to bottom from Washington. I have trouble trusting what they have to say.
I just wish we could get reliable data that does not come with an agenda and just compares apples to apples.
As far as life expectancy is concerned, that will not get better until individual Americans learn to eat right, exercise a little, and generally stop abusing their bodies with drugs and alcohol and promiscuity and probably a dozen other things. You can bet a lot of that extra money is keeping us alive in spite of our bad habits.
I think the president could do a lot with hard nosed negotiating on drug prices. They should also do what they can to promote competition from the compounding pharmacies. I use compounded semaglutide for weight loss. It sets me back $30/week, which is well within my budget. But, as almost of us here know, President Trump has a lot of irons in the fire and I don’t think he needs more right at this moment.
Reforming education is a whole other ball of wax. For the time being, I am hoping that the rush away from expensive, burdensome and useless university degrees and toward skilled trades starts putting the pressure on that issue. And under no circumstances should student loans be forgiven. I graduated in 1979 with $9000 in student loans. That was 50% of my starting salary. I had to drive a Chevette for a few years, but I got those loans paid off. On time. Paying bills on time is one aspect of what they call these days “adulting”, and I think kids need a lot of practice. They can start by diligently paying their debts.
Well,that is about all I have to bloviate about tonight. Good night, everyone.
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