Insurance companies are a real problem with this.
I had a minor surgery on my face to remove a cancer.
I was approved, medicare/BCBS, for cosmetic surgery.
The surgeon was approved but her facility was not.
She did the surgery at the hospital in the OR.
Only one way to fix this stuff.
ANYONE who enters an operating room without authorization should be kicked out IMMEDIATELY.
I would never interrupt a surgery for a phone call. I would say I assumed it was a prank or a mistake.
This is an example of why many doctors are adopting concierge care for their practice. It is also a major reason you no longer see doctors in solo practice but as part of a group under the control of the hospital.
“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.”
Wrong the health insurers’ job is to make sure it can show a profit to its investors. It is a business. To them unnecessary care is not care that is not medically warranted but care that threatens their bottom line. If it was about protecting the patient there would be no need for contracts spelling out just what they will or won’t allow. You would pay your premium and deductible and they would cover percentage of the bill agreed upon.
I sense a lack of business acumen here: taking out a $3.5 million loan to get her practice started?
I once had an insurance company send me a letter signed by their medical Director saying they were denying coverage for my legend blood pressure medication because I had not tried other cheaper drugs in the same class. I was very tempted to bring a malpractice claim against the medical director since he was making a diagnosis and prescribing medication without ever seeing me as a patient.
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
“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.
“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.
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.
Insurance companies are evil.
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........
as for not allowing her clinic to become in-network has to do with her credentialing and billing practices i would guess
Granted United is the worst of the worst but this is the kind of BS which will guarantee single payer.
An “open doors” audit of all of Congress, of their possible holdings in these companies would be interesting. ✖️👀