Surgeon Accuses UnitedHealthcare of Interfering in Surgery and Retaliation on TikTok
TL/DR –
Dr. Elisabeth Potter, a plastic surgeon, received a call from UnitedHealthcare during a surgery seeking more information on why the patient needed an overnight hospital stay. Potter has accused the insurer of denying coverage for the hospital stay and retaliating against her for her social media posts about the incident, putting her clinic at risk of bankruptcy. UnitedHealthcare has not allowed her clinic, RedBud Surgery Center, to join their in-network list of providers, which Potter says could force her out of business as the insurer is the second biggest player in the market.
Doctor Interrupted by Health Insurance Company During Breast Surgery
Dr. Elisabeth Potter, renowned plastic surgeon, was interrupted during a <=a href="https://www.nbcnews.com/news/us-news/united-healthcare-insurance-plastic-surgery-rcna13853">breast reconstruction surgery in January by a representative from UnitedHealthcare needing immediate information about her patient. Potter recorded a TikTok video recounting this interference, which has now been viewed nearly six million times.
The UnitedHealthcare representative sought justification for the patient’s overnight hospital stay, despite the surgery already being approved. Potter expressed her disbelief and concern about this intrusive interaction, arguing that the healthcare system has lost its way.
UnitedHealthcare denied making such an inappropriate request and rejected accusations of interrupting patient care. The company acknowledged an error with a separate request but insisted they had approved the patient’s hospital stay.
Ongoing Feud between Potter and Health Insurance Giant
Potter claimed retaliation from UnitedHealthcare due to her social media exposure, putting her at risk of bankruptcy. She asserts that her clinic, the RedBud Surgery Center in Austin, Texas, has been disallowed from joining the UnitedHealthcare network. As a result of this exclusion, Potter’s ability to operate at her clinic is compromised, despite her still being in-network as a surgeon.
This exclusion may potentially force Potter out of business, with her inability to accept UnitedHealthcare patients. Already $5 million in debt, Potter fears the severe consequences of UnitedHealthcare’s denial, considering its dominance in the market as per the Texas Department of Insurance.
Insurance Companies’ Stranglehold on Healthcare Providers
The growing tension between insurers and healthcare providers is exemplified by Potter’s dispute. Dealing with insurance companies is a constant struggle for doctors in the US, especially with claim denials, prior authorizations, and other barriers to care. This struggle persists even for in-network providers; a study by the health policy research group KFF revealed that an average of 17% of claims were denied in 2021, even when patients received care from in-network doctors.
UnitedHealthcare, under the parent company UnitedHealth Group, has been under intense scrutiny for potential antitrust violations, Medicare billing practices, and attempts to silence critics, including Potter.
Need for Systemic Insurance Reforms
Potter argues that it’s imperative to reform the broader healthcare system, expressing strong support for health insurance as it makes care more affordable for patients. However, she criticizes the insurance companies’ control over the practice of medicine, describing it as arbitrary and cruel.
Despite the challenges and personal debt incurred, Potter remains determined to provide needed surgeries for women at the RedBud Surgery Center. She stresses the need for patients who are medically appropriate to have their surgeries at her clinic, as it’s economically beneficial for the system and necessary for keeping her practice open.
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