'Out of control': Cancer surgeon claims UnitedHealthcare questioned her mid-procedure
a year ago by pelespirit to c/usa
A breast cancer surgeon had to "scrub out mid-surgery" to call a UnitedHealthcare representative because the insurance giant questioned whether the procedure she was in the middle of performing was really necessary.
Dr. Elisabeth Potter posted her story to Instagram this week, and the post has gotten more than 221,000 likes.
Still wearing her scrub cap, Dr. Potter began her video saying, "It’s 2025, and navigating insurance has somehow just gotten worse."
Some dirt bags are slightly less bad than other dirtbags. That's why I have Comcast Internet.
Who could possibly be worse than comcast.
Wow was cheap and fast for me... And would go down for 3 days at a time inexplicably. Oh, and they sent me a modem-router combo with cascade routers disabled and a firmware flash that prevented me from changing it, evnthough I specifically requested (and paid for) modem only.
Cincinnati Bell was actually half decent.
Their name is literally pronounced "cocks". It really says it all
I'm curious as well. I haven't met worse.
It’s the inverse of “the grass is always greener”. The internet service is always shittier.
A complete lack of internet would be worse than Comcast, but it’s honestly a pretty close thing.
Can't speak any the companies in the south or on the coasts but Comcast is easily one of the best residential Internet providers in the Midwest.
I'm not fan of Comcast but I dealt with pretty much every provider out there when I was an integrator (IT and AV for rich people) and it's not even close.
Let that sink in...that's how shitty the other ISPs are.
Sad to say, my company was bought by another, and i am forced to change to these dirt bags. I currently have a malady that will require surgery. Not that it matters, the old company declined my last surgery anyway and i paid out of pocket
Push back when it's auto-declined. You can often get them to pay up even if they decline at first. They're trying to make as much profit as possible, so they decline and hope you don't fight back.
I mean thats the thing right? Except it’s not that easy. The billing man at the practice has been trying, and when i call i get the, “your claim has been reviewed by a human and denied.” Canned response. And i have to go through the call carousel. And now my job changed providers, so now i am trying to get back pay from a healthcare company i don’t have an active account with. But i really don’t want to have half my jaw amputated.
I sure wish someone would do something about this.
We need a hero. Someone who will do whatever it takes even sacrifice themselves if necessary to proclaim, "this is not okay. You will not get away with this."
Mass movements always exist, you just have to join them.
But mass movements also demand a lot of your time and energy, which you may not have if you're staring down the barrel of multiple major medical procedures. What's more, they demand a political system receptive to their demands.
The appeal of stocastic violence is that it doesn't require an enormous long term collaborative good faith effort. It just requires a few vigilantes with more rage than sense.
After decades of campaigning on health care reform (literally straight back to the 1940s) and posting a ton of Ls (particularly since Carter and the neoliberal turn), Luigi might not be transformative but he's cathartic.
What's more, they demand a political system receptive to their demands.
Not necessarily. That's only for mass protests, which are the way Western governments trick their citizens into wasting their time and motivation without effecting real change. As you escalate you have methods like striking and rioting (and armed revolution if all else fails, but America isn't that far gone yet) that are capable of twisting the elites' arm into cooperating. This is why movements like the Civil Rights movement and early 20th century labor movements worked but the Iraq war protests didn't. Ultimately protesting is an implied threat that means nothing if you have no intention to follow up on it.
I've been hearing for decades that the 2nd amendment is fundamental to the American identity, because it's supposed to be an insurance against this type of tyranny against the American people. There you have your mass movement, making claims on that insurance, using what's purported to be fundamental to the national identity of the country. What tyranny is the 2nd amendment protecting against if this doesn't make the cut?
It's really hard to disagree with Luigi when he wrote "evidently, I am the first to face it with such brutal honesty". Brutal honesty is what this state of affairs calls for. It's time to water Jefferson's proverbial tree of liberty.
A mass movement of bannable and actionable suggestions
Someone call user4616250
Nope, y'all don't need (or deserve tbh, speaking as someone not from the US) a hero. You should try to hold your own government accountable for once; the last time that happened was the Civil Rights Movement I think?
You don't get it. Most of us get zero paid leave. I had two days, which I thought about taking during a slow week. My boss said you should save them. I got an email on January 1 saying they were gone.
Can't go wrong with Hitchcock.
My partner had this same thing happen. She needed a neurosurgery to install a nerve stimulator in her neck. Her insurance approved a surgery to implant a test device, but then when it was determined it did solve her issues, denied the surgery for the permanent stimulator, forcing her neurosurgeon to write to them to get it approved. Then, during the surgery, they sent another denial. Fortunately, U of M is fantastic, and their hospital just covered the cost of the surgery due to the level of bullshit the insurance company pulled. Otherwise she would have ended up with multiple scars on her head and neck, and nothing to show for it, other than continuing nerve pain.
There was one single doctor in a fifty mile radius who would deliver my youngest because UHC. Had there been zero, we could've gone to anyone and they'd have had to cover it, but because there was one provider, we had to use him.
It reminds me of enshittification, in that the end product involves both regular people and businesses customers being fucked over (but the regular people are fucked over worse/for long). In this analogy, the doctors are the business customers. Enshittification doesn't apply here though, because this system has always been shitty for everyone, even if it's getting worse. If this scenario "rhymes" with enshittification, it's just because they both are based on capitalism being toxic
Well, if enshittification is understood as "making it more shitty" rather than "turning it into shit", then it's perfectly possible to further enshittify that which is already shit.
Personally I favour the latter definition since otherwise we would need another word for "making a shitty thing even worse".
Yeah, I do agree with you. However I do like Doctorow's pithy, 3 step formulation, which lends itself to the stricter definition. But he does also say that he may have coined it, but it's not his word, so go nuts
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"Enshittification names the problem and proposes a solution. It’s not just a way to say “things are getting worse”, though, of course, it’s fine with me if you want to use it that way. [...] But in case you want to be more precise, let’s examine how enshittification works. It’s a three-stage process: first, platforms are good to their users. Then they abuse their users to make things better for their business customers. Finally, they abuse those business customers to claw back all the value for themselves. Then, there is a fourth stage: they die." ^1
UHC has an enormous client pool, though. Their business model involves lots of kickbacks to HR/Execs and tons of money on marketing, as well as regulatory capture and consolidation/cartelization of competitors.
"Well, I simply won't do business with you" isn't a practical option for most hospitals, particularly in the ER or other time sensitive setting.
I could be wrong, but I believe ER visits are handled differently?
It only speaks to how bad UHC is that even though their business model is marketing and kickbacks, there are still providers who don't want to have anything to do with them.
Remind me again when this shit started happening? Not like it was being prevented before Trump or Biden or Obama or Bush. Honestly I could go back pretty far. Nobody is stopping these companies from doing what they're doing it's not gonna change.
Fuck trump because we all know what's gonna happen but in this specific situation nobody will do anything even if Biden or Harris were running the show.
Yeah, it's hilarious. Most of the surgeons I work with voted for Trump...
Are any of them not assholes? Are any of them not rich? Every surgeon I've met is a rich asshole. Rich people voted trump, assholes voted trump.
Yeah, you got it. There are a rare few that aren't total douchebags.
I'd love to hear more about the decent ones. Because my perception is so skewed to think every surgeon is an asshole. I had one of the dumbest conversations of my professional life with one if you'd like.
Medical insurance companies should be forced to also provide life insurance to the same customer.
Then they have incentive to keep their customers alive.
Idk if it's only for like 200k and the procedure costs more than that then they have an incentive to kill you
That's true but it's a business. Yes they would prefer to pay nothing but if the law passed they had to cover life insurance then they straight up have a number to beat. If it's gonna cost $200,001 to keep you alive then nope, denied.
Universal healthcare would have the same effect. The government would spend a lot more money on preventative care.
Looking at Canada and Sweden as models, they absolutely do. Getting an actual specialist appointment takes a long long time, but they do get there eventually. And they def do a better job at getting you the meds you need in a timely fashion.
Getting an actual specialist appointment takes a long long time
Well, thank the gods of capitalism that I only have to wait 5 months to see a specialist (for a basic intake appointment, mind you, not even one for any real treatment) for the debilitating spinal injury that is causing me severe pain and mobility issues every second of every day. I'd hate to have affordable universal health care that might make me wait to see a specialist.
It's not, I'm advocating for universal healthcare.
Preventative care is DIRT CHEAP compared to any treatment or management of any condition.
No, no, they should only be required to provide life insurance for deaths related to refused treatments, but the amount should be massive and punitive. Whoops, you died because we denied your treatment, your next of kin gets several times more than we could have hypothetically saved by denying the treatment.
You can't make it a massive punitive amount of it's general life insurance because everyone dies eventually. But you can if it's for deaths related to a denied treatment, and you can make it high enough that the financial incentive is always in favor of approving necessary treatments.
Cigna has this cool new thing they do where, after they deny a medication for our son, they have a nurse call us and tell us why our doctor was wrong to prescribe it in the first place. You know, because a nurse who has never been in the same room as my son knows more than the fucking doctor who examined him.
Jesus Christ that’s horrible. Fucking manipulative pieces of shit
I have Cigna. Did you catch the email they sent before the new year? In 2025 you need to centralize your prescriptions between either CVS or Walgreens (with exceptions for small pharmacies I didn't look into). They didn't even send a physical letter, just an email they hoped would be ignored or missed.
I'm sure there are so many people already getting surprise huge bills at the pharmacy in 2025. Luckily I saw the email and put all my prescriptions at a CVS all the way across town instead of the Walgreens two minutes away. Because that CVS has one of my prescriptions that Walgreens seems permanently out of. Absolute fucking bullshit.
No, I didn't hear about that. I normally send my prescriptions to CVS anyway, since they're down the street, but sometimes I send it to my local doctors office's pharmacy when they can't fill it. I'm gonna be pisse if they give me shit for that.
I think it's cool for local stuff, you're probably fine. Check your email.
We need to make it a crime to deny claims on necessary healthcare. 10x penalty (paid to the victim directly) for denial. 30x if they were denied using AI or an automated system.
Just make it not up to the insurance company. If the healthcare provider believes it's necessary care, then the insurance company pays. Full stop. They get no say in the matter, and denial is not an option.
"But health insurance would become unprofitable!", they'll cry? Good. Necessity shouldn't be exploited.
This would incentivize abuse of the system by quacks and malicious profiteers trying to overbill, but Medicare/Medicaid seem to manage that problem just fine through fraud laws/policies.
If the insurance company believes it's actually unnecessary care, they can take up a complaint with the medical board and only get to claw back money if an independent panel of doctors in the same specialty agrees that it was unnecessary or unethical. A bonus from this is that insurance companies would have incentive to make sure doctors are well-trained to know what testing/treatment is actually warranted. Btw, "necessary" doesn't only get to mean you get the minimum required to keep you from dying today; quality of life and long-term prognosis must be required considerations.
If the insurance company believes it's fraud, they can take it up with law enforcement too.
Another thing that could help would be to make the medical/nursing/etc boards better equipped for investigation/enforcement of ethics complaints and to make disciplinary records follow those who would move to another state to get a new license, and also make those disciplinary records readily accessible by the public on a centralized national database. Bad actors will not be able to continue being bad actors if they lose their license, can't get a new one, or wind up in jail.
Even better, let's just have a national healthcare system.
Sure, but in this theoretical ideal world we wouldn't have the problem of being without insurance either. That is, if we had universal Medicare instead of a for-profit insurance industry, then no one would be without insurance. The Centers for Medicare and Medicaid services dictates what they'll pay if you want to get reimbursement from them at all (unless you're a pharmaceutical company, for some reason, then you can charge whatever you want), and the hospitals where MRI/CT/etc. machines are housed would all quickly crumble without any Medicare/Medicaid reimbursements (and actually would be better off financially if half their ER patients were not uninsured).
And if we can't rely on their benevolence, then the licensing board or law enforcement would theoretically address any problems. Ideally, anyway.
I hope the surgeon said, at least, "Even if you conclude against my advice that it wasn't necessary based on your data before this call, it is most definitely necessary now, as the patient is open on my operating table at this moment." <slam>.
Police recovered bullets at the scene that read, "delay, deny, defend
Depose. Say it, DEPOSE.
I can understand this one instance being an editorial slip-up, but I’ve seen way too many news articles that reference the bullets while omitting that one particular word - depose.
It’s the word that scares the oligarchs the most. Which is all the more reason for us to repeat it, even if journalists won’t. DELAY, DENY, DEPOSE.
Good catch! Thank you, I fixed my comment.
At this point if I ever switched jobs and the new employer had United Health Care I would politely thank them for their time and get up and walk out of the interview.
Unfortunately most people can't be so picky as to walk out of an interview, but yeah we should normalize asking who the company insurance is through, and if it's UHC, out.
I mean, maybe an interviewer will tell you what they have if you ask, but HR and the recruiters will not, and the company policy is going to be "you will get your employee handbook and benefits selection guide after starting."
Only when they start costing more than they're expected to produce in future profits. So less like a parasite and more like a soulless corporate leech, because actual parasites at least want the host to survive until they can reproduce.
One cannot be a true medical doctor in the USA.
This is one of the reasons I want to be a night shift emergency medicine physician. No one is calling me at 2 in the morning to argue with me running a code for insurance reasons.
Yeah they'll just deny it without talking to you and bankrupt your patient.
There's special kinds of short-term Medicaid for emergency room treatment and associated hospitalization. And they can't deny a resuscitation as "not medically necessary".
And they can't deny a resuscitation as "not medically necessary".
You have too much faith in their new AI
At the very least there should be a law, forcing any health insurance to at least cover all costs needed to insure survival and long term health. And what is needed for survival and long term health is defined by the Doctor and not by the insurance company!!! Honestly, no idea why this is not law in any rich country in 2025!
All the other rich countries in 2025 just have free healthcare and don't need that law.
You guys need other kind of UHC.
If you need experts, most of them are members of post-soviet communist partues and know how to build Semashko system.
I don't know any surgeons personally, not any more, but my ex-wife was an RN that worked exclusively in surgery. I can't see any of those people stepping out of a surgery for a call from the insurance company. Hell, I called her mid-surgery, thinking I was having a heart attack and she hesitated to leave. And she was just the nurse!
Most of those guys were seriously crusty. Just can't see a surgeon saying, "Gosh! I have to bail mid-procedure and take this insurance call!" For that matter, I can't see anyone who would dare interrupt a working surgeon for anything short of a drastic family matter, maybe not even then. Something smells about this story.
It happened to my partner as well. I put most of it in its own comment, but she found out from her surgery team, as she was waking up afterward, that they had been told mid-procedure that the surgery wouldn't be covered.
Like what bullshit is that. Once the surgery has started I think you've lost the ability to deny anything.
Exactly. You approved it, already. You can't then un-approve it once things are rolling, based on your own say so.
You approved it, already.
You can't wait for insurance approval on certain procedures - appendicitis, for instance. You've got to file the claim and hope they approve it.
And insurance companies love to slow roll claims approval, particularly in situations where saying "we need more time to consider" means a higher likelihood of the patient dying before receiving care. Liver cancer is a common case.
Imagine a surgeon scrubbed out of surgery mid-way, to talk to an overly-entitled bean-counter about the necessity of a surgical procedure that's in progress.
I imagine that call to have a tone about as blistering as the surface of the sun.
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Proud to say as of the first of the year I'm no longer insured with these dirtbags.
I'm now insured with some other dirtbags.
save