A surgeon in Austin, Texas, was in the middle of an operation when she was notified of a call from the patient’s insurance company.
Dr. Elisabeth Potter is a board-certified plastic surgeon who specializes in reconstruction for women who have had this breast cancer. Last year alone, she performed approximately 520 operations for cancer patients.
She recently shared a video talking about the experience.
“I just performed two bilateral DIEP flap surgeries and two bilateral tissue expander surgeries,” she said in the now-viral video.
(DIEP flap reconstruction uses skin, fat, and blood vessels from the patient’s abdominal area to rebuild the breasts.)
Dr. Elisabeth Potter, a surgeon from Texas, recently shared a video talking about a phone call that came in from an insurance company during a patient’s surgery. (Dr. Elisabeth Potter; @drelisabethpotter)
During one of the DIEP cases, while the patient was sleeping on the operating table, the doctor was interrupted by a nursing supervisor who informed her that a call had come in from UnitedHealthcare, the patient’s insurance company, Potter said.
The nurse who answered the call said it was Potter during an operation and not available.
“And they said, I need to message her because we need to talk to her about this patient,” Potter told Fox News Digital. “So they wrote a note and brought it to the operating room and I took a picture of it because I was like, I can’t believe this is happening.”
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The note included the name and number of the person UnitedHealthcare was to call, along with the patient’s name and Dr. Potter. (The note did not indicate that the caller had requested an immediate response.)
“The nurse at the front desk of the OR who answered and wrote this note said the person on the phone asked about the patient first and then about me,” Potter told Fox News Digital.
“I made that decision and I stand by it. I think it was the right thing to do for the patient.”
“He was told I had been washed in the OR and he asked the nurse if I would be contacted in the OR and he would get the message.”
Potter added: “The nurse manager said she had never received a call like this in her career. She felt it should be important and brought the message to the OR.”
Dr. Elisabeth Potter, a surgeon in Austin, Texas, was in the middle of an operation when she was notified of a call from the patient’s insurance company. (Dr. Elisabeth Potter; @drelisabethpotter)
It was strange, Potter said, that the insurance company had called the reception of the hospital, where she is not an employee.
“They didn’t call my office. They didn’t call my cell phone. They didn’t send me an email. This was not the hospital billing department.”
Afraid that the insurance company would deny the patient treatment, Potter decided to stop mid-surgery and call back United.
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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 anesthesia team who were completing 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 “afraid” 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, she said.
“I’ve seen it before, when people get stuck with bills of $80,000 or $100,000,” she told Fox News Digital. “And so I said to my partners, ‘I’m going to make a call real quick.'” (See her video here.)
“Dealing with insurance is a very important part of caring for patients affected by breast cancer because the diagnosis is financially devastating.”
“If it had been at a critical time during the operation, I wouldn’t have done that,” Potter clarified. “But I made that decision and I stand by it. I think it was the right thing to do for the patient.”
On the phone, the insurance company indicated that they needed to know this diagnosis of the patient and the justification for the hospital stay, something Potter had already communicated, she said.
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“And I thought, wait a minute, we’ve been cleared for the surgery. We’ve submitted all our clinical documentation. We’ve done all the paperwork, the phone calls, all the stuff. You’ve got her diagnosis codes, you’ve got all of them,” continued them.
“And they said, ‘Actually, I don’t have that, another department has that, but I need this now,’” Potter said. “There was a sense of entitlement to my time and to the information at that moment,” the surgeon added.
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Potter also noted that the person on the phone did not have access to the patient’s entire file medical informationdespite the fact that the procedure has already been approved in advance.
“I’m not sure that person even understood that they were having an impact on the patients I was operating on,” Potter told Fox News Digital. ‘They were just thinking money and numbers and didn’t understand it at all.”
Potter was “afraid” 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, quite frankly, unacceptable,” she told Fox News Digital. “Patients and caregivers deserve better than this. We need to focus on care, not bureaucracy.”
Potter noted that she has always been “committed” to providing in-network care through insurance.
“Dealing with insurance is a very important part of caring for patients affected by cancer breast cancer, because the diagnosis is financially devastating,” she told Fox News Digital.
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“I’ve found that I really have to immediately think about insurance and whether it covers treatments and what my patients experience.”
Potter emphasized that she doesn’t think insurance is “bad,” noting that there are some “really good things” about companies that take care of 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 developed into something that is no longer considered patient care. This is just a machine running and making money, and they don’t care about me as a provider,” she said.
Many doctors have given up and refuse to do business with insurance companies. They choose to stay out of network and have the patient pay up front and handle the reimbursement, Potter noted.
“Patients and caregivers deserve better than this.”
“I went to Washington, DCI fought to protect access to (breast) reconstruction,” she said. “I have testified in the state legislature on these issues.”
She added, “It’s just coming undone. And in this moment, this week, it was like we crossed a line: They’re actually in the operating room.”
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Fox News Digital reached out to UnitedHealthcare for comment. The company sent the following statement.
“There are no insurance-related circumstances that require a physician to leave surgery and it would pose potential safety risks if he did.”
It continued: “We have not asked for and would never expect a physician to interrupt patient care to answer a call, and we will be reaching out to the provider and hospital to understand why these unorthodox actions are undertaken.”
Separately, the head of the UnitedHealthcare group said Thursday that the company “remains focused on making high-quality, affordable health care more available while making the health care system more easily accessible to patients and providers.” (iStock)
In addition, the head of the UnitedHealthcare group said Thursday that the company is confident it will be able to grow its business in fiscal 2025.
“The people of UnitedHealthcare remain focused on making quality, affordable healthcare more available to more people while making the healthcare system easier to navigate for patients and providers, leaving us well-positioned for growth in 2025,” said CEO Andrew Witty in the company publication. earnings report Thursday.
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His optimism comes shortly after the head of New York City’s insurance department was shot, sparking a heated conversation about the role of the health insurance industry in the United States.
Fox News Digital’s Daniella Genovese contributed reporting.
