Dr. Elisabeth Potter, a plastic surgeon in Austin, Texas, recently shared a shocking story about an insurance company interrupting her during a cancer surgery. Potter was performing a bilateral DIEP flap surgery, a reconstruction procedure after a mastectomy, when she received a call from UnitedHealthcare.
The insurance company representative demanded information about the patient’s diagnosis and justification for the inpatient stay. Potter had to scrub out mid-surgery to take the call, only to find that the person on the line did not have access to the patient’s full medical information, despite the procedure being pre-approved. “I was like, do you understand that she’s asleep right now and that she has breast cancer, and the gentleman said, ‘Actually, I don’t.
That’s a different department that would know that information,'” Potter recounted. “It’s out of control. Insurance is out of control.
Insurance interference during cancer surgery
I have no other words.”
Potter’s experience highlights broader issues within the health insurance industry, where financial metrics often take precedence over medical ones. Michael Ryan, a finance expert and founder of MichaelRyanMoney.com, described this as an “attrition strategy,” where administrative hurdles serve as profit protection mechanisms for insurance companies.
Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, noted the strained relationship between the public and health insurance providers, with individuals paying a significant portion of their earnings for coverage only to be denied care when they need it most. UnitedHealthcare responded to the incident, stating, “There are no insurance-related circumstances that would require a physician to step out of surgery, and it would create potential safety risks if they were to do so. We did not ask nor would ever expect a physician to interrupt patient care to answer a call.”
The controversy surrounding UnitedHealthcare’s practices is part of a broader debate about the role of insurance companies in denying necessary care.
The company is currently facing a lawsuit claiming it illegally denied patients necessary care under Medicare Advantage plans by using an AI model with a known 90% error rate. Dr. Potter emphasized the pervasiveness of insurance pressure in healthcare, stating, “There is no room in healthcare where the pressure of insurance isn’t felt by both patients and doctors.
Not even the operating room. This is already out of hand.”