A surgeon in Austin, Texas, was in the middle of an operation when she received a phone call from the patient’s insurance company.
dr. Elisabeth Potter is a board certified plastic surgeon specializing in reconstruction for women who have had breast cancer. Last year alone, she performed around 520 operations on cancer patients.
She recently shared a video where she talks about her experience.
“I just had two bilateral DIEP flap surgeries and two bilateral tissue expander surgeries,” she said in the now-viral video.
(In DIEP flap reconstruction, skin, fat tissue and blood vessels from the patient’s abdominal area are used for breast reconstruction.)
dr. Elisabeth Potter, a Texas surgeon, recently shared a video of a phone call she received from an insurance company during a patient’s surgery. (Dr. Elisabeth Potter; @drelisabethpotter)
During one of the DIEP cases, while the patient was asleep on the operating table, the doctor was interrupted by a nurse supervisor to inform her that a call had come in from UnitedHealthcare, the patient’s insurance company, Potter said.
The nurse who took the call said it was Potter in surgery and is not available.
“And they said, I need to text her because we need to talk to her about this patient,” Potter told Fox News Digital. “They wrote a note and brought it into the operating room and I took a picture of it, because I’m like, I can’t believe this is happening.”
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The message listed the name and number of the person to call at UnitedHealthcare, along with the name of the patient and the name of the doctor. Potter. (The note did not indicate that the caller requested an immediate response.)
“The nurse at the front desk of the OR who took the call and wrote this message said the person on the phone was asking for the patient first and then for me,” Potter told Fox News Digital.
“I made that judgment and I stand by it – I think it was the right thing to do for the patient.”
“He was told that I was scrubbed[to the] OR asked the nurse to contact me in the OR and give me a message.”
Potter added, “The nurse said she’d never received a call like that in her career. She thought it must be important and took the note into the operating room.”
dr. Elisabeth Potter, a surgeon from Austin, Texas, was in the middle of surgery when she received a phone call from the patient’s insurance company. (Dr. Elisabeth Potter; @drelisabethpotter)
It was strange, Potter said, that it was insurance company called the reception of the hospital where she is not employed.
“They didn’t call my office. They didn’t call my cell phone. They didn’t email me. This is not a hospital billing department.”
Fearing that the insurance company might deny the patient service, Potter made the decision to delete mid-surgery to return United’s call.
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The surgeon told Fox News Digital that UnitedHealthcare did not require her to leave the operating room or threaten to deny coverage.
The patient was safe with another surgeon and anesthesiology team finishing the procedure.
dr. Elisabeth Potter is a board-certified plastic surgeon in Texas who specializes in breast reconstruction for women who have had breast cancer. (Dr. Elisabeth Potter)
Potter was “scared” the patient would wake up to find the insurance company said they didn’t have the information they needed and would deny the claim, she said.
“I’ve seen it before, when people get stuck with $80,000 or $100,000 bills,” she told Fox News Digital. “And so I said to my partners, ‘I’m going to make this call very soon.'” (See her video here.)
“Dealing with insurance is a really important part of breast cancer patient care, because the diagnosis is financially devastating.”
“If it had been at a critical moment during the operation, I wouldn’t have,” Potter clarified. “But I made that judgment and I stand by it – I think it was the right thing to do for the patient.”
On the phone, the insurance company said they needed to know patient diagnosis and justification for the hospital stay, something Potter had already communicated, she said.
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“And I said, wait a minute, we’ve been cleared for surgery. We’ve submitted all our clinical records. We’ve done all the paperwork, the phone calls, all the stuff. You’ve got her diagnostic codes, you’ve got all of that,” she continued.
“And they said, ‘Actually, I don’t, another department has that, but I need this now,'” Potter said. “There was a feeling that I was entitled to my time and information at that point,” the surgeon added.
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Potter also noted that the person on the line did not have access to the patient’s kit medical informationdespite the fact that the procedure has already been previously approved.
“I’m not sure that person even understood that he had an impact on the patients I was operating on,” Potter told Fox News Digital. “They were just thinking money and numbers and they had no understanding at all.”
Potter was “terrified” the patient would wake up and find out the insurance company said they didn’t have the information they needed and would deny the claim, the surgeon told Fox News Digital. (iStock)
“It’s beyond frustrating and, frankly, unacceptable,” she told Fox News Digital. “Patients and providers deserve better than this. We should be focused on care, not bureaucracy.”
Potter noted that she has always been “committed” to providing in-network care through insurance.
“Insurance business is a really important part of care for affected patients breast cancer, because the diagnosis is financially devastating,” she told Fox News Digital.
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“I found that I really had to get directly involved and think about insurance and whether they cover that treatment and what my patients are experiencing.”
Potter emphasized that she doesn’t think insurance is “evil,” pointing out that there are some “really good things” about companies that care about people.
It was strange, the surgeon thought, that the insurance company called the reception of the hospital, where she was not an employee. (iStock)
“But this has evolved into something he no longer devotes himself to patient care. This is just a machine that works and makes money, and they don’t care about me as a service provider,” she said.
Many doctors have given up and refuse to work with insurance companies, choosing to stay out of network and let the patient pay up front and handle the reimbursement, Potter noted.
“Patients and providers deserve better than this.”
“I left Washington, DCI fought to protect access [breast] reconstruction,” she said. “I’ve testified in the state legislature on these issues.”
She added, “It becomes irreparable. And this moment, this week, it was like we crossed the line — they’re actually in the operating room.”
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Fox News Digital has reached out to UnitedHealthcare for comment. The company sent the following statement.
“There are no insurance-related circumstances that would require a physician to forego surgery and would create potential safety risks if they did so.”
It continued: “We did not ask, nor would we ever expect, a physician to interrupt patient care to answer a call and we will follow up with the provider and the hospital to understand why these unorthodox actions were taken.”
Separately, the head of UnitedHealthcare Group said Thursday that the company remains “focused on making high-quality, affordable health care more accessible while making it easier for patients and providers to navigate the health care system.” (iStock)
Separately, the head of UnitedHealthcare Group said Thursday that the company is confident it will be able to grow its business in fiscal 2025.
“The people at UnitedHealthcare remain focused on making high-quality, affordable healthcare more accessible to more people, while making the healthcare system easier for patients and providers to navigate, which positions us well for growth in 2025,” said CEO Andrew Witty in the company reported earnings on Thursday.
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His optimism comes shortly after the head of its insurance unit was shot and killed in New York, sparking a heated conversation about the role of the health insurance industry in the United States.
Fox News Digital’s Daniella Genovese contributed reporting.
