United States | News & Politics @midwest.social

4w ago

'Out of control': Cancer surgeon claims UnitedHealthcare questioned her mid-procedure

www.rawstory.com 'Out of control': Cancer surgeon claims UnitedHealthcare questioned her mid-procedure

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...

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."

117 comments

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.
- Some dirt bags are slightly less bad than other dirtbags. That's why I have Comcast Internet.
  
  Who could possibly be worse than comcast.
- 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 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."
- Nah, we need to realize this isn't on any one person's shoulders but on everybody and start a mass movement.
  
  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.
  
  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?
  
  Then the FBI shot MLK.
  
  How about using the wonderful internet and social media to sync calendars so you can all take out the quarter of a toilet break you americans call "paid holiday" and gather up, pool resources in order to make the federal government non functional until things improve. Rather than talking big about grabbing for the literal gun and doing drive-bys. The damn french go for the jugular for as little as government implementing points system for driving liscences.
- Mama mia!

Calling it now:
UHC will deny the anesthesia claim because they wont understand why they needed so much time to perform the procedure.

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.

- What a sick gif...
  
  Can't go wrong with Hitchcock.

There are doctors and providers who just don't take UHC because they are such a pain in the ass to deal with.
- 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
- 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.

Well, you assholes voted in trump and the republican cabal so dont expect any change soon.
- 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.

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
  
  In the current scenario, they have to pay nothing if they kill you. It's just pure savings. In the other, they have to pay $200k.
  
  I think it's sick that you can put 250k into your body to heal and that doesn't increase the value of your body. Idk, makes life insurance that much more ghoulish.
- Universal healthcare would have the same effect. The government would spend a lot more money on preventative care.
  
  That.... Doesn't sound like a bad thing.
  
  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.
  
  Preventative care is DIRT CHEAP compared to any treatment or management of any condition.
- I like this line of thinking, but I expect they'd just lobby to make the life insurance payout requirements lower than the expected cost of treatment.
  
  Lobbying should be handled legally the same as bribes.
- 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.

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.

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.
  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 they 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.

CEO got killed but everything still working as intended. For everyone who was worried I can bring relieve, UnitedHealthcare is still working well.

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.
- Dude, you got the words wrong too: https://en.m.wikipedia.org/wiki/Luigi_Mangione (See "Alleged Role ...".)
  (EDIT: The parent comment now has the correct words!)
  In your defense, the cops initially reported the words from the bullet casings incorrectly before later making a correction. And half the media has been confused about it ever since.
  
  Good catch! Thank you, I fixed my comment.

Doctors across the country need to adopt a "just fucking do it" attitude, and tell their legal departments to fuck off.
On this and other topics.
- The problem with that is that they care about their patients, and it’s their patients who will suffer the most when the insurance company tells them both to fuck themselves.
  
  The problem is not billing the company when the patient needs healthcare, regardless of what the company insists they will or won't cover.
  Don't tell me 'well they can't just charge insurers whatever whenever' when they have no fucking issue billing patients obscene amounts months after the fact.

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.
- Or, remove the ticks.
  Make health insurance illegal. Single payer healthcare where all is approved.
- 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.
  
  Healthcare providers charge people without insurance the cost of an MRI machine for using the MRI machine tho. I wouldn't rely on their benevolence.

The Adjuster has entered the chat.

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."

Insurance companies are parasites killing their host.
- 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.

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.
- I mean that's basically all medicine besides some very specific aesthetic services. Even plastic surgeons do some amazing work sewing people's faces back on after animal attacks and industrial accidents and whatnot. This is a medical journal article of an amazing facial reconstruction after a car crash but fair warning that in the initial images his face is basically... gone (Scary Link). I've also heard stories of general and trauma surgeons trying to find a plastics doctor at 2am to sew a toddler's face back on after various accidents because while part of stitching anything up is minimizing scarring the delicate skin of a tiny face that has a lot more growing to do is just outside of their skillset once the injury is past a certain surface area.

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.
  
  Yeah, but did they finish? That was the point of my post. I can't see a surgeon saying, "Well, pack it up boys, not covered." Let alone personally taking a call.
- 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.

117 comments