Surgeon Says UnitedHealthcare Pulled Her Out Of A Surgery To Justify Her Cancer Patient's Hospital Stay
She was afraid if she didn't interrupt the surgery to take the call they wouldn't cover the procedure.
David Pereiras | Shutterstock We've all known for ages that America's healthcare system is profoundly broken, but the stories that have emerged since the murder of UnitedHealthcare CEO Brian Thompson have thrown the situation into shocking relief.
A plastic surgeon's recent experience is a perfect example. It's the kind of mystifying story that makes you wonder how we even got here.
The surgeon said UnitedHealthcare pulled her out of an operation to justify a cancer patient's care.
Yes, you read that right. Dr. Elisabeth Potter is a plastic surgeon based in Austin, Texas who specializes in deep inferior epigastric perforator surgery, or DIEP, a type of reconstructive surgery for breast cancer and mastectomy patients.
Recently, she had an experience she said had never before happened in her lengthy career. "I got a phone call into the operating room saying that UnitedHealthcare wanted me to call them about one of the patients who was having surgery today — who was actually asleep having surgery," she said. "And said I had to call right now."
Dr. Potter had to leave her patient in the middle of surgery to haggle over her patient's hospital stay.
Just in case it's not crystal clear, this is a cancer patient, in the midst of major surgery. But for whatever reason, the insurer's phone call simply could not wait. Dr. Potter said she had to scrub out of the operation, leave her patient on the operating table with her body cut open, and go take the call.
"The gentleman said he needed some information about her, wanted to know her diagnosis and whether her inpatient stay should be justified," Dr. Potter explained. "And I was like, do you understand that she's asleep right now, and she has breast cancer?"
It turned out to be a valid question — the UnitedHealthcare employee on the other end knew basically nothing about the patient in question and told Dr. Potter "That's a different department."
The patient's hospital stay and surgery had already gone through pre-approval with UnitedHealthcare in the first place.
Dr. Potter, of course, did her job and pointedly told the employee that yes, her cancer patient having major and potentially dangerous reconstructive surgery would need to stay in the hospital, for God's sake.
Even more infuriating, she'd already been over this with UnitedHealthcare. "I was like… you have all the information with you, because I got approval for this surgery, and I need to go back and be with my patient now."
She was left utterly mystified by the experience. "Insurance is out of control," she said. "I have no other words." Naturally, her video instantly went viral, which Dr. Potter said was surprising. But she's glad it got so much reach.
"We all need to know what's really going on in healthcare," she said before putting a finer point on it: "Insurance companies really do control when and what kind of care we deliver."
Dr. Potter explained that American healthcare has become a 'fear-based' system where she is afraid to not take insurer's calls.
UnitedHealthcare's demands are so absurd you may be wondering why Dr. Potter even agreed to leave her patient in the first place. But she had a very good reason, and it all came down to that patient herself.
"It's almost like a fear-based system where if an insurance company calls me and says I gotta call them right back, like, I'm afraid they're not gonna pay for my patient's surgery," she said, "that that patient's gonna get stuck with a bill."
Knowing the way health insurers operate, that's probably true — and they'd probably slap an extra fee on the bill for having to call back multiple times. It's sobering to know that even a doctor of Potter's stature is as mystified and bullied by health insurers as many patients are.
That, in the end, is why she made her video. “I’m done being quiet about what's going on in healthcare. I'm done pretending like this is OK,” she said. “I became a doctor because I wanted to help people. And instead of helping people, I spend so much of my time trying to appease insurance companies and get them to value what I do and value my patients. And that's gotta stop.”
Here's hoping we can all keep speaking out and bring about change because this system is barbaric.
John Sundholm is a writer, editor, and video personality with 20 years of experience in media and entertainment. He covers culture, mental health, and human interest topics.