Texas Surgeon Says Unitedhealthcare Dispute May Force Her Into Bankruptcy

In January, Dr. Elisabeth Potter said she was midway done performing a bosom reconstruction room erstwhile a telephone from a typical from UnitedHealthcare came into nan operating room. The wellness security institution wanted to talk astir nan diligent connected nan table.

“I sewage a telephone telephone into nan operating room saying that UnitedHealthcare wanted to talk to maine and that they wanted to talk to maine now,” Potter, a integrative surgeon, told NBC News. Potter posted a video connected TikTok recounting nan telephone that’s reached astir 6 cardinal views.

During nan telephone she said nan UnitedHealthcare typical wanted much accusation connected why nan diligent needed an overnight infirmary stay, moreover though nan room itself had already been approved.

“The personification connected nan telephone asked for her diagnosis, for nan diligent who was nether anesthesia connected nan table,” she said. “That telephone was conscionable this wake-up call. If they tin ringing maine successful nan operating room, not for thing urgent, conscionable for that, and to inquire maine to warrant her staying overnight … we person mislaid our way.”

Potter acknowledged that it was her determination to measurement retired of nan room to return nan call. But “in 2025 pinch insurance,” she said, “when they opportunity ‘jump,’ I say, ‘how high?’”

Dr. Elisabeth Potter.Courtesy Dr. Elisabeth Potter

A spokesperson for UnitedHealthcare said nan institution “did not inquire — nor would it ever expect — a expert to interrupt diligent attraction to return a telephone telephone astir a notification correction aliases immoderate different security matter.”

Potter said UnitedHealthcare denied sum for nan infirmary stay. The security spokesperson said nan enactment was approved but location was an correction pinch a abstracted request.

Now, Potter said she believes UnitedHealthcare is retaliating against her because of her societal media posts, putting her astatine consequence of bankruptcy.

The wellness security company, she said, has not allowed her session — nan RedBud Surgery Center successful Austin, Texas — to subordinate their in-network database of providers. She started nan session successful April 2024. Potter herself remains successful network, meaning she tin execute surgeries successful a hospital, but because nan installation is retired of network, she can’t run there.

(In web intends a wellness insurer has a statement pinch a wellness attraction provider, agreeing to salary for services astatine preset rates. Out of web intends there’s nary contract, truthful nan insurer could salary little aliases not astatine all. Patients are acold little apt to spot out-of-network doctors because, without security paying, nan patients must screen nan full cost.)

Without being capable to judge UnitedHealthcare patients successful network, Potter said she apt won’t beryllium capable to enactment successful business. While she’s successful talks to subordinate different insurers’ networks, UnitedHealthcare is nan 2nd biggest subordinate successful nan market, according to nan Texas Department of Insurance.

Potter said she’s presently $5 cardinal successful indebtedness and her hubby had to rate retired his 401(K) to thief them enactment afloat.

If you are dealing pinch bills that look to beryllium retired of statement aliases a denial of coverage, attraction aliases repairs, whether for health, location aliases auto, please email america astatine Costofdenial@nbcuni.com.

“My extremity has ever been, really do I make this work? I’m a problem-solver,” she said. “The truth that they clasp nan strings successful that way, that they’re capable to power nan economics of nan believe of medicine down to nan installation that I’m operating in, it seems conscionable arbitrary and besides somewhat cruel.”

The UnitedHealthcare spokesperson said nan institution informed Potter that its web was closed to caller centers successful October 2024, good earlier she began posting nan societal media videos. The spokesperson besides said location was already a capable number of room centers successful nan area by Potter’s clinic.

The spokesperson added that Potter’s advisor continued to scope retired to nan institution aft October, but “there were nary ongoing negotiations.”

Potter said that UnitedHealthcare remained successful interaction pinch her advisor until January, astir nan clip she posted nan viral video. “I don’t cognize really United defines negotiations, but location were ongoing communications pushing for maine to beryllium successful network,” she said.

Ongoing tensions

Potter’s dispute, experts say, is 1 illustration of ongoing hostility betwixt insurers and wellness attraction providers.

Dr. Adam Gaffney, a captious attraction expert and assistant professor of medicine astatine Harvard Medical School, said that dealing pinch wellness security companies is “part and parcel” of nan life of astir doctors successful nan U.S.

Gaffney, who did not speak specifically astir Potter’s lawsuit but nan manufacture successful general, said that portion of wellness insurers’ jobs is to forestall unnecessary attraction arsenic a measurement to antagonistic nan exorbitant costs of wellness attraction successful nan U.S., from pricey narcotics to costly infirmary stays.

But for galore doctors, that intends perpetually dealing pinch anterior authorizations, declare denials and different barriers to attraction that patients request — sometimes moreover aft nan attraction has already been given, he said. That applies moreover erstwhile providers are successful network: A study from nan wellness argumentation investigation group KFF recovered that successful 2021 insurers denied an mean of 17% of claims, moreover erstwhile patients received attraction from in-network doctors.

“I deliberation this is nan incorrect measurement to do it,” Gaffney said. “There’s nary mobility that fighting pinch security companies is not why group signed up to beryllium doctors.“

The difficulties patients and providers look pinch wellness security companies drew renewed attraction past twelvemonth aft nan fatal shooting of Brian Thompson, nan CEO of UnitedHealthcare, successful New York City.

UnitedHealth Group — nan genitor institution of UnitedHealthcare — has been nether aggravated scrutiny. Following nan decease of Thompson past year, nan institution disclosed in a regulatory filing successful July that it’s facing a civilian and criminal investigation from nan Justice Department aft reports of a probe related to its Medicare billing practices. The institution is besides being investigated for imaginable antitrust violations, The Wall Street Journal reported, citing group acquainted pinch nan matter. The institution told WSJ successful a connection that it stands “by nan integrity of our Medicare Advantage program.”

In May, Andrew Witty, nan CEO of UnitedHealth Group, suddenly stepped down, citing “personal reasons.”

A New York Times report published successful July said nan wellness insurer has sought to soundlessness journalists, filmmakers and wellness attraction professionals who knock them online. The Times’ study cites a number of sources by name, including Potter. In a statement, a spokesperson for nan institution told nan Times, “The truth matters, and there’s a large quality betwixt ‘criticism’ and irresponsibly omitting facts and context.”

“I deliberation much and much group are coming to understand that security companies are doing a bully woody of nan rationing that is simply a portion of nan American wellness attraction system,” said Arthur Caplan, nan caput of nan section of aesculapian morals astatine NYU Langone Medical Center successful New York City. “I deliberation that nan strategy that we have, backstage for-profit entities telling america what our aesculapian attraction should be, is ridiculously immoral.”

“It’s going to return superior authorities intervention,” Caplan added. “If we don’t do it, we’re still going to upwind up pinch each these disputes arsenic insurers effort to incorporate costs.”

Keeping nan lights on

Potter agreed that nan broader wellness attraction strategy needs fixing, adding that she feels “strongly” that wellness security is simply a bully point arsenic it makes attraction much affordable for patients.

Potter said she near infirmary activity and opened her ain session successful April 2024 aft realizing she could supply nan aforesaid services astatine a little costs to some patients and security companies — while earning much herself.

“I’m conscionable trying to do surgeries that women request and for illustration successful nan champion measurement possible,” she said.

She said she took retired $3.5 cardinal successful individual loans to unfastened nan clinic, moreover jumping done hoops to get it certified truthful they could legally judge backstage security and Medicaid patients, thing that not each room centers are capable to do.

“It’s specified a scam,” she said. “You person to walk each nan wellness hurdles erstwhile you build a room halfway to make judge it’s a safe spot for patients. And then, arsenic personification who wants to supply care, past you person to attack security companies.”

Because of security issues, she said she’s presently not taking a net and whitethorn only person a fewer months near to enactment successful business.

“All I want is for nan patients who are medically due to beryllium astatine RedBud Surgery Center to person their surgeries here, aforesaid attraction for patients, and it helps support my doors unfastened and nan lights on, and it’s little costly for nan system.”