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

[cbabe]

https://www.rawstory.com/out-of-control-cancer-surgeon-tells-of-insurance-co-questioning-her-mid-procedure/

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

Jennifer Bowers Bahney
Jan 9, 2025

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.

…

She continued, saying that while performing a Deep Inferior Epigastric Perforator, or "DIEP," breast reconstruction for a cancer patient, "I got a phone call into the operating room saying that UnitedHealthcare wanted me to call them about one of the patients who was having surgery today — who's actually asleep, having surgery."

"And, you know, said I had to call 'right now.' So, I scrubbed out of my case and I called UnitedHealthcare, and the gentleman said he needed some information about her. Wanted to know her diagnosis and whether her inpatient stay should be justified. And I was like, 'Do you understand this? She's asleep right now and she has breast cancer?' And the gentleman said, 'Actually, I don't — that's a different department that would know that information.'"

… more …

[Trueblue1968]

34. Put that insurance worker in jail. ....he would murder the patient.

[unblock]

2. Insurance is out of control, yes; but why did the surgeon take the call mid-procedure?

Other than my immediate family, if anyone tells me I need to call them "right now", I finish what I'm doing, especially if it's something major like surgery (not that I do any surgery).

And I don't think this is really a story if the surgeon had just waited until after the procedure.

I have very, very little sympathy for medical insurance companies these days, but I think this is a non-story.

[cbabe]

3. Don't know why the surgeon took the call. Could be

insurance threatened to cancel if doctor didn’t take the call. As has happened.

A friend was in a similar situation just being sedated for heart procedure. Procedure was pre approved until it wasn’t.

Took hours and hospital admins to get re-approval.

Stress not so great for a heart patient.

[unblock]

6. I think once the procedure has started, they should finish it and resolve any insurance matters after

Sure, some procedures can be interrupted or rescheduled without medical consequence, but I don't think that applies when anesthesia is involved given the risks.

[cbabe]

8. That sounds correct and medically best. Until lawyers and money people stick their noses in. Which is the stupid

glaringly horrible maddening problem.

[UniqueUserName]

10. It's amazing how some people want to put the onus on the healthcare provider. . .

. . .instead of on the conniving, lying, sneaky, greedy insurance company and its executives and representatives.

[3Hotdogs]

38. Yeah. Poor judgement. I wouldn't want her as my surgeon for anything more than a hangnail.

[ShazzieB]

39. I agree in principle, but there's a major power disparity in play here that can't be ignored.

In our warped and twisted "health care" system, the insurance companies literally hold the power of life and death over patients and tremendous power of another kind over health care providers and hospitals. No matter what the patient needs and the doctor wants to provide, it's the insurance company who gets to decide what actually happens, by providing or withholding coverage. Very wealthy patients who can afford to pay out of pocket when the insurance company says no are the only ones who are exempt from this unhealthy (pun intended) power dynamic.

Health care providers know this, and they have to battle it on a daily red.basis. I'm sure it has a huge impact on them. In this particular case, I suspect that the doctor felt it would be too risky to go ahead and complete the procedure without being sure that it would be covered, knowing that the patient could be thrown into a catastrophic financial situation thereby.

Also, most hospitals in the U.S. these days are (regrettably) "for profit" and would not look favorably on a doctor performing an expensive procedure for which coverage was not pre-approved and running up bills that might not get paid.

Like it or not, the health care of most Americans is now under the control of people without medical training who are sitting in offices miles from where the care is taking place and who are probably under incredible pressure themselves to decide in favor of maximizing the company's profits rather than providing the best possible care for patients.

The choice that doctor made to scrub out and take the call was far from ideal, but she may have felt that she was stuck between the devil and the deep blue sea and literally had no choice. Would she have been able to get away with not taking the call right at that moment? Maybe? But the stakes were so high that she may not have dared take that risk.

It's incredibly fucked up, but that's where we are right now, here in the good old USA.

[unblock]

40. That's for sure, it's an incredibly f*cked up way of delivering healthcare

Providers and patients should never be in such a situation.

Once insurance gives approval, it should be binding once the procedure starts.

[mahina]

20. We have that luxury. This doc was protecting the patient

[yardwork]

26. There was probably a very good reason.

If the surgeon hadn't taken the call, it's very possible the insurance company would have refused to pay, leaving the patient with tens of thousands of dollars of medical bills.

It happens all the time.

[unblock]

28. How is a partial procedure billed??

Is there actually a negotiate rate for interrupted procedures??

[yardwork]

32. I'm not sure I understand your question.

What I'm saying is that if the surgeon hadn't taken not taken the call from the insurance company, but finished the surgery and then called back, it's very possible the insurance company would have refused to pay for the surgery - and possibly all the other care as well.

This is not uncommon. This is probably why the surgeon stepped out of the OR to take the call.

This is what's going on.

[unblock]

35. So what happens if half a surgery takes place, then is put on hold for more insurance questions.

Insurance insists on another test or more information from the patient, so surgery is rescheduled. Then it never happens for some reason, or happens under a different insurance carrier because the patient's company switched carriers at year-end.

How do they bill the partial surgery? I guess some of it is hourly, like maybe the anesthesiologist's time and the o.r. room rental. But the procedure itself?

[yardwork]

36. The insurance company probably wouldn't pay at all.

They don't care if the procedure is done or not. If they decide not to authorize it, the patient is on the hook, even if the surgery was done, half-done, whatever.

I knew someone who got pre-authorization for breast reconstruction after she had breast cancer, and weeks after the surgery was completed, the insurance company decided not to pay after all. She had to get a lawyer and fight them.

In terms of what the hospital and physician might bill the patient for a partial procedure, I don't know.

[Unladen Swallow]

33. Exactly

Every second someone is kept under anesthesia is a risk to them. Scrubbing out to take a phone call? My curious mind wants to know the details.

[hlthe2b]

4. While I don't want to criticize the surgeon, but she was not "asleep!" She was under GD ANESTHESIA!!!

Good gawd. I am so damned tired of this dumbing down medical information to those who damned well should understand the terms--given they were the ones responsible for reviewing her medical claims. To convey that the patient was at risk--given she was anesthetized (AND NOT MERELY 'ASLEEP' was the responsibility of the surgeon in speaking to that idiot insurer. She was the representative for the health and welfare of the patient and thus had the responsibility to accurately and fully convey the situation to that idiot). Why some here do not understand that and instead suggest I am not blaming the insurance people is beyond any honest assessment of what I wrote. So stop it!

Don't ask me what I dream about some of these insurance lackeys. I do censor my feelings when awake but...

[unblock]

7. I'm sure the surgeon fully understands the terms, but I'll give them a pass when talking to a reporter

Assuming the reporter even quoted the surgeon accurately....

[cbabe]

9. Seems kinda mean to pick on the surgeon for word use when insurance

is the real villain.

Plus common language and euphemisms are commonly used when speaking outside one’s specialized field.

Surgeon wouldn’t know some harassing phone clerk’s level of medical expertise when expertise is in harassment.

[hlthe2b]

12. Give me a damned break. I did not remove the insurance idiot's responsibility, but the surgeon

need to emphasize that pulling her out of that surgery WHILE the patient was under anesthesia PUT THE PATIENT AT RISK. The patient was not merely sleeping. She needs to convey that. And I sure as hell do NOT appreciate your intentional misrepresentation of what I said.

[hlthe2b]

13. "under anesthesia" is beyond your understanding? REALLY?

[unblock]

18. Of course I understand it. Just saying either the surgeon or the reporter or the editor might have dumbed it down

[hlthe2b]

16. your misintepretation is beyond the pale, cbabe...

To convey that the patient was at risk--given she was anesthetized (AND NOT MERELY 'ASLEEP' was the responsibility of the surgeon in speaking to that idiot insurer. She was the representative for the health and welfare of the patient and thus had the responsibility to accurately and fully convey the situation to that idiot). Why some here do not understand that and instead suggest I am not blaming the insurance people is beyond any honest assessment of what I wrote. So stop it!

[hlthe2b]

11. What the hell? I never even implied that the surgeon did NOT understand the terms. WTF?

I am talking about the silly damned habit that some think they should have to do to talk to someone--the insurance asshole with the authority to deny claims and THUS SHOULD BE EDUCATED ON BASIC TERMS. None of my colleagues do that. We speak simply and at the level appropriate to true "lay" patients and others with a minimum of highly technical jargon, but we don't dumb it down for those who should know better.

Nor do we talk about " buttcracks" or "pits" or "pubes" or other crass terms like the drifting supposed ob/gyn and creator of Lume-- who sounds like she is auditioning for a damned porn film. Is this why some think we are all supposed to speak like a damned moron or the most uneducated sex worker?

[cbabe]

15. Ummm. Ok. Bye now.

[hlthe2b]

17. Gratefully...

Good gawd...

[unblock]

22. I think you're reading much too much into some of the posts on this thread.

Personally, I've had several dealings with reporters. A few are very smart and diligent. But most are fairly ignorant about the matter they are covering (it's the nature of the job; even a expert science reporter can't be up on every corner of every branch of science) and most reporters and editors think their audience is even more ignorant, so they dumb things down, and often the expert they are interviewing dumbs it down in advance.

Clarifying my own position that the surgeon understood the terms even if they dumbed it down for a reporter wasn't meant to imply anything about your perspective. Sorry if this wasn't clear.

[hlthe2b]

23. I am talking about what the surgeon said to the insurance official, not a reporter. It is the surgeon's

solemn responsibility to advocate for their patient and that means being specific as hell about what is going on and the risks currently being incurred. I do so for my patients and I will not be told by you or anyone else that I should NOT. You should be demanding your physician, surgeons, pharmacists and others involved in your care do the SAME. I can guarantee you that insurance official would know EXACTLY what was going on had they spoken to ME and they would not dare want to incur the responsibility that I would put on THEM for any adverse consequences of their ACTIONS. That is called patient advocacy.

If the reporter writing about this re-interpreted and misquoted then that is on them and their stupidity, but my point remains.

[unblock]

24. I have no particular insight into that conversation except the surgeon's account as filtered through the reporting

So sure, I imagine it was appropriately technical and that the surgeon advocated for the patient. I expect this is normal and have no reason to question it. Not sure why you would think I would.

[progree]

19. The title of your #4 had me confused --

While I don't want to criticize the surgeon, but she was not "asleep!" She wasn"t under GD ANESTHESIA!!!

Did you mean "was" instead of "wasn't"?

Anyway, that might be the reason for the strange responses.

you say later in the post (which some readers might have glossed over despite the all-caps, given that the excerpt below is from a long paragraph -- long for some people anyway) --

...

To convey that the patient was at risk--given she was anesthetized (AND NOT MERELY 'ASLEEP' was the responsibility of the surgeon in speaking to that idiot insurer.

I'm not a medical professional or even close to that, but yes. even I know that being under general anesthesia is a lot different than just sleeping.

[hlthe2b]

21. Yes... Thank you for taking the time to read & think about it rather than make the accusations

that the others inexplicably did. Good gawd. I had a typo in the subject line but made it clear in the remainder of the post what I meant AND I made it very clear that I was not supporting the damned insurance company. So for one of the other posters to suggest otherwise is offensive as hell.

The edit will be made. Thank you.

[Irish_Dem]

5. UHC is lying, they knew exactly what they was doing with this case.

When I interacted with UHC when I was still working as a provider,
they constantly lied, played dumb, passed the buck.

They worked so hard and were good at it, I had to assume they were making a percentage of
all the claims they denied.

They also love to lie, manipulate and torment providers.

[progree]

14. "Collins described crying .. while handling calls from desperate patients, as supervisors laughed." [UnitedHealthcare]

UnitedHealthcare taught us ways to deny claims: Former employee, News Nation, 12/28/24

A former UnitedHealthcare claims representative says employees were systematically trained to deny medical claims and rush distressed customers off phone lines, revealing internal practices at the nation’s largest health insurer amid growing scrutiny of the industry.

Natalie Collins, who worked for UnitedHealthcare for nine months, said Saturday on “NewsNation Prime” that staff received “so many different ways to deny” claims during their two to three months of training, with supervisors often standing behind representatives instructing them on denial methods.

“We weren’t given proper instruction to actually pay the claim, and there wasn’t enough monies in certain files in certain companies to pay medical claims,” Collins said. “We would have to just get the client off the phone as fast as we could.”

Collins described crying at her desk while handling calls from desperate patients, as supervisors laughed.

Collins, now the owner of “Mother’s Keeper Doula,” quit her position after attempting to approve payment for a widowed mother of five whose husband died of pancreatic cancer, saying supervisors had instructed her to deny the hospice claim and get the caller “off our phone line.”

https://www.msn.com/en-us/news/crime/unitedhealthcare-taught-us-ways-to-deny-claims-former-employee/ar-AA1wDB5Q

[yardwork]

25. Americans don't have to stand for this.

[Jilly_in_VA]

27. Doesn't surprise me in the least

I wouldn't put anything past these predators.

[Bristlecone]

29. And their stock was $8 up yesterday, and touted as a "market leader"

We need Universal Healthcare. Enough with this for-profit bullshit. It is a human rights issue.

[Evolve Dammit]

30. Fucking gross abuse of power.

[LuckyLib]

31. This is an example of folks unable to say no. Whoever

received the call needed to refuse to pass it along, saying the message would be passed along via the usual channels. The doctor, reached in an operating room needed to say no. Are we such slaves to insurance bureaucrats that we can’t stand up to them?

[NBachers]

37. I think I would second-guess the insurance company before I second-guessed the doctor. But that's just me.

[KS Toronado]

41. Drop everything you're doing and talk to me, an insurance agent !!!

Think that agent deserves a good talking to, they are not as important in life as police, firemen
or doctors.