Surgeon shares story of insurance provider calling during patient's surgery
A surgeon in Austin, Texas, was in the middle of surgery when she was notified of a phone call from the patient’s insurance provider.
Dr. Elisabeth Potter is a board-certified plastic surgeon who specializes in reconstruction for women who have had breast cancer. Last year alone, she did about 520 surgeries for cancer patients.
She recently shared a video of herself 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.
(In DIEP flap surgery reconstruction, skin, fat and blood vessels from the patient's abdominal area are used to rebuild breasts.)
During one of the DIEP cases, while the patient was asleep on the operating table, the doctor was interrupted by a nurse supervisor informing her that a call had come in from UnitedHealthcare, the patient's insurance company, Potter said.
The nurse who took the call said that Potter was in surgery and not available.
"And they said, I need to get her a message because we need to talk to her about this patient," Potter told Fox News Digital. "So 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."
HEALTH CARE IS ‘OVERWHELMINGLY COMPLEX’ FOR OLDER ADULTS, EXPERTS SAY: ‘EVER-INCREASING HURDLE’
The note indicated the name and number of the person to call at UnitedHealthcare, along with the patient’s name and Dr. Potter’s name. (The note did not state that the caller had requested an immediate response.)
"The nurse at the front desk of the OR who took the call and wrote this note said that the person on the phone first asked for the patient and then for me," Potter told Fox News Digital.
"He was told I was scrubbed in[to the] OR and he asked the nurse that I be contacted in OR and given the message."
Added Potter, "The nurse manager said she had never in her career received a call like that before. She thought it must be important and brought the message to the OR."
It was odd, Potter said, that the insurance company had called the front desk 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 wasn't the billing department of the hospital."
Afraid that the insurance company might deny the patient’s service, Potter made the decision to scrub out mid-surgery to return the call to United.
BOY FACING BLINDNESS GETS LIFE-CHANGING EYE SURGERY: ‘SUCH A BLESSING’
The surgeon stated to 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 the anesthesia team, who were finishing up the procedure.
Potter was "scared" that the patient would wake up and find out that 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 that are $80,000 or $100,000," she said to Fox News Digital. "And so I said to my partners, ‘I’m going to make this call real quick.’" (See her video here.)
"If it had been at a critical moment during the surgery, I wouldn't have," Potter clarified. "But I made that judgment call and I stand by that — I think it was the right thing to do for the patient."
On the phone, the insurance company stated that they needed to know the patient’s diagnosis and the justification for the inpatient stay, something Potter had already communicated, she said.
WOMAN RECEIVES PIG KIDNEY TRANSPLANT, WALKS OUT OF HOSPITAL DAYS LATER: ‘SECOND CHANCE'
"And I was like, wait a minute, we got authorization for the surgery. We submitted all of our clinical documentation. We've done all the paperwork, the phone calls, all the stuff. You have her diagnosis codes, you have all of it," she went on.
"And they said, 'Actually, I don't, another department has that, but I need this right now,'" Potter said. "There was a sense of entitlement to my time and to the information in that moment," the surgeon added.
CLICK HERE TO SIGN UP FOR OUR HEALTH NEWSLETTER
Potter also noted that the person on the line didn’t have access to the patient’s full medical information, despite the procedure already being pre-approved.
"I’m not sure that person even understood that they had an impact on those patients I was operating on," Potter told Fox News Digital. "They were just thinking about money and numbers and were not understanding at all."
"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 "devoted" to providing care in-network through insurance.
"Dealing with insurance is a really important part of taking care of patients affected by breast cancer, because the diagnosis is financially devastating," she told Fox News Digital.
"I've found that I really have to engage directly and think about insurance and whether they're covering treatments and what my patients are experiencing."
Potter emphasized that she doesn’t think insurance is "evil," noting that there are some "really good things" about businesses that take care of people.
"But this has developed into something that no longer is devoted to patient care. This is just a machine that's running and making money, and they don't care about me as a provider," she said.
Many physicians have given up and refuse to deal with insurance companies, opting to stay out of network and let the patient pay upfront and deal with getting reimbursed, Potter noted.
"I've gone to Washington, D.C., I have fought to protect access to [breast] reconstruction," she said. "I have testified in the state legislature about these issues."
She added, "It's just getting undoable. And this moment, this week, was like, we've crossed a line — they're actually in the operating room."
HEALTH CARE OR HOUSING? MORE STATES ARE USING MEDICAID FUNDS TO HELP THE HOMELESS
Fox News Digital contacted UnitedHealthcare for comment. The company sent the following statement.
"There are no insurance-related circumstances that would require a physician to step out of surgery and it would create potential safety risks if they were to do so."
It went on, "We did not ask nor would ever expect a physician to interrupt patient care to answer a call and we will be following up with the provider and hospital to understand why these unorthodox actions were taken."
Separately, the head of UnitedHealthcare group said on Thursday that the company is confident it will be able to grow its business in fiscal year 2025.
"The people of UnitedHealthcare remain focused on making high-quality, affordable health care more available to more people while making the health system easier to navigate for patients and providers, positioning us well for growth in 2025," CEO Andrew Witty said in the company's earnings report on Thursday.
For more Health articles, visit www.foxnews.com/health
His optimism comes shortly after the head of its insurance unit was gunned down in New York City, inciting a heated conversation about the role of the health insurance industry in the United States.
Fox News Digital's Daniella Genovese contributed reporting.