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After the last call, my nurse practitioner Whitney and I processed how ridiculous it is that the person scheduled to speak with me, reviewing the careful documentation and clinical notes, was not a plastic surgeon. We fight for our patients and work so hard, but also see the absurdity...

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Elisabeth Potter MD

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17,628 Aufrufe • vor 4 Monaten •via X (Twitter)

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Last night, I got a late call from a breast surgeon here in Austin, TX. Her 22-year-old patient— just days away from a mastectomy—found out the plastic surgeon she had been seeing is out-of-network and her insurance doesn’t cover any out-of-network care. So now what? The breast surgeon called me and asked for a favor, knowing I take cases like this on, even if the payments are low…too low to cover the costs for me and my practice…because I think it’s the right thing to do. My team is doing everything we can to get her seen this week and to get her case approved. But here’s the thing: this isn’t a one-off. This is yet another example of how having insurance doesn’t mean you have access to care. These narrow networks are failing patients. This young woman has cancer now. She needs surgery now. And we don’t have the luxury of time to wait for policy change. The sad reality is I can’t afford to keep doing this for patients, even though I want to. We need a better system for patients and for the doctors trying to care for them. I believe we can fix this. But we need the help of the government. We need laws to change, and we don't have the luxury of time.
1:46

Last night, I got a late call from a breast surgeon here in Austin, TX. Her 22-year-old patient— just days away from a mastectomy—found out the plastic surgeon she had been seeing is out-of-network and her insurance doesn’t cover any out-of-network care. So now what? The breast surgeon called me and asked for a favor, knowing I take cases like this on, even if the payments are low…too low to cover the costs for me and my practice…because I think it’s the right thing to do. My team is doing everything we can to get her seen this week and to get her case approved. But here’s the thing: this isn’t a one-off. This is yet another example of how having insurance doesn’t mean you have access to care. These narrow networks are failing patients. This young woman has cancer now. She needs surgery now. And we don’t have the luxury of time to wait for policy change. The sad reality is I can’t afford to keep doing this for patients, even though I want to. We need a better system for patients and for the doctors trying to care for them. I believe we can fix this. But we need the help of the government. We need laws to change, and we don't have the luxury of time.

Elisabeth Potter MD

48,458 Aufrufe • vor 1 Jahr

INSANE 🚨 This surgeon has a patient who needs a “deep flap” surgery. Insurance denied it To appeal she had to speak to her patients insurance. “I actually asked, do you know what a deep flap is? THE DOCTOR SAID NO.” The insurance companies deciding if Americans get their procedures DONT EVEN KNOW what the procedures are. How is this okay?! THIS is the state of American healthcare… “You may remember I had a patient who needs a deep flap, and the insurance company denied an inpatient stay for her. So I had to schedule a peer to peer call and schedule time out of my day to ask for a conversation directly with someone who is my peer to discuss deep flap surgery and why that patient needed to be overnight. That call was scheduled for 11AM, and eleven came around 11: 30, 11: 45 and no call still. And then we emailed the insurance company because, of course, they don't give me the call number. They only let me receive the call. So finally at 12: 15, I received the call that was initially scheduled for 11. And the doctor who called me was not a surgeon. And I actually asked the doctor, do you know what a deep flap is? And the doctor said no. So that's where we are. My patient has insurance. She's seeing someone who's fellowship trained in microsurgery, me, to do her breast reconstruction, and I'm having to teach another doctor what a deep flap is in order to justify her overnight stay to navigate her insurance. This is completely ridiculous.”
1:12

INSANE 🚨 This surgeon has a patient who needs a “deep flap” surgery. Insurance denied it To appeal she had to speak to her patients insurance. “I actually asked, do you know what a deep flap is? THE DOCTOR SAID NO.” The insurance companies deciding if Americans get their procedures DONT EVEN KNOW what the procedures are. How is this okay?! THIS is the state of American healthcare… “You may remember I had a patient who needs a deep flap, and the insurance company denied an inpatient stay for her. So I had to schedule a peer to peer call and schedule time out of my day to ask for a conversation directly with someone who is my peer to discuss deep flap surgery and why that patient needed to be overnight. That call was scheduled for 11AM, and eleven came around 11: 30, 11: 45 and no call still. And then we emailed the insurance company because, of course, they don't give me the call number. They only let me receive the call. So finally at 12: 15, I received the call that was initially scheduled for 11. And the doctor who called me was not a surgeon. And I actually asked the doctor, do you know what a deep flap is? And the doctor said no. So that's where we are. My patient has insurance. She's seeing someone who's fellowship trained in microsurgery, me, to do her breast reconstruction, and I'm having to teach another doctor what a deep flap is in order to justify her overnight stay to navigate her insurance. This is completely ridiculous.”

Wall Street Apes

1,292,441 Aufrufe • vor 1 Jahr

22-year-old patient just days away from a mastectomy denied by her insurance to see another Doctor, since her doctor is out of town. Last night, I got a late call from a breast surgeon here in Austin, TX. Her 22-year-old patient just days away from a mastectomy found out the plastic surgeon she had been seeing is out-of-network and her insurance doesn’t cover any out-of-network care. So now what? The breast surgeon called me and asked for a favor, knowing I take cases like this on, even if the payments are low…too low to cover the costs for me and my practice…because I think it’s the right thing to do. My team is doing everything we can to get her seen this week and to get her case approved. But here’s the thing: this isn’t a one-off. This is yet another example of how having insurance doesn’t mean you have access to care. These narrow networks are failing patients. This young woman has cancer now. She needs surgery now. And we don’t have the luxury of time to wait for policy change. The sad reality is I can’t afford to keep doing this for patients, even though I want to. We need a better system for patients and for the doctors trying to care for them. I believe we can fix this. But we need the help of the government. We need laws to change, and we don't have the luxury of time.
1:46

22-year-old patient just days away from a mastectomy denied by her insurance to see another Doctor, since her doctor is out of town. Last night, I got a late call from a breast surgeon here in Austin, TX. Her 22-year-old patient just days away from a mastectomy found out the plastic surgeon she had been seeing is out-of-network and her insurance doesn’t cover any out-of-network care. So now what? The breast surgeon called me and asked for a favor, knowing I take cases like this on, even if the payments are low…too low to cover the costs for me and my practice…because I think it’s the right thing to do. My team is doing everything we can to get her seen this week and to get her case approved. But here’s the thing: this isn’t a one-off. This is yet another example of how having insurance doesn’t mean you have access to care. These narrow networks are failing patients. This young woman has cancer now. She needs surgery now. And we don’t have the luxury of time to wait for policy change. The sad reality is I can’t afford to keep doing this for patients, even though I want to. We need a better system for patients and for the doctors trying to care for them. I believe we can fix this. But we need the help of the government. We need laws to change, and we don't have the luxury of time.

Wall Street Mav

92,506 Aufrufe • vor 1 Jahr

This is a Neurosurgeon at UCLA He has a patient that has brain tumors 🚨 UnitedHealthcare has denied his patient a MRI for lifesaving imaging and THEY’RE DENYING DOING PEER TO PEERS A Peer to Peer is how doctors could appeal the insurance company decision “So UnitedHealthcare has once again disappointed me as an insurance company because they not only denied an MRI for one of my patients that needed advanced sequences for tumor surgery, but they denied a peer to peer. Now, I thought things were supposed to get better after all the complaints on social media, the heat that they've had from all the public opinion. But to take away the peer to peer process and have us fill out a form that they're going to fax to us at some unknown time and date, this patient literally needs the SARI so that we can do a safer brain tumor surgery, and yet now they're removing the avenues through which we can even apply for that. — UnitedHealth, if you are going to deny our ability to order scans or labs that are crucial for carrying out safe patient care, at least make the appeal process easier so that we can do so”
1:11

This is a Neurosurgeon at UCLA He has a patient that has brain tumors 🚨 UnitedHealthcare has denied his patient a MRI for lifesaving imaging and THEY’RE DENYING DOING PEER TO PEERS A Peer to Peer is how doctors could appeal the insurance company decision “So UnitedHealthcare has once again disappointed me as an insurance company because they not only denied an MRI for one of my patients that needed advanced sequences for tumor surgery, but they denied a peer to peer. Now, I thought things were supposed to get better after all the complaints on social media, the heat that they've had from all the public opinion. But to take away the peer to peer process and have us fill out a form that they're going to fax to us at some unknown time and date, this patient literally needs the SARI so that we can do a safer brain tumor surgery, and yet now they're removing the avenues through which we can even apply for that. — UnitedHealth, if you are going to deny our ability to order scans or labs that are crucial for carrying out safe patient care, at least make the appeal process easier so that we can do so”

Wall Street Apes

782,676 Aufrufe • vor 1 Jahr

Another peer-to-peer call. The reviewer was kind. Really kind. But, respectfully, not my peer. He listened as I explained why my patient needs lymphovenous bypass surgery. It’s a surgery that can treat the painful swelling in her arm caused by breast cancer treatment and prevent it from getting worse. She has done everything right. Compression. Therapy. Expensive garments. She’s changed her life to spend an hour a day with every resource she can afford. It’s affecting her ability to work as a nurse. And she is getting worse. This is the window where we can fix it. Early enough that surgery can actually change the course. We can do this surgery outpatient. Two hours. CMS even has a code for it. The man on the phone agreed it would help her… But he couldn’t approve it… Because he’s not a plastic surgeon and doesn’t have the specific knowledge necessary to make this recommendation. He gave me the help he felt he could. He told me to appeal and told me not to expedite it, because that wouldn’t work in my favor. Every human involved in this case knows what we should do. But the system is inhumane.
1:39

Another peer-to-peer call. The reviewer was kind. Really kind. But, respectfully, not my peer. He listened as I explained why my patient needs lymphovenous bypass surgery. It’s a surgery that can treat the painful swelling in her arm caused by breast cancer treatment and prevent it from getting worse. She has done everything right. Compression. Therapy. Expensive garments. She’s changed her life to spend an hour a day with every resource she can afford. It’s affecting her ability to work as a nurse. And she is getting worse. This is the window where we can fix it. Early enough that surgery can actually change the course. We can do this surgery outpatient. Two hours. CMS even has a code for it. The man on the phone agreed it would help her… But he couldn’t approve it… Because he’s not a plastic surgeon and doesn’t have the specific knowledge necessary to make this recommendation. He gave me the help he felt he could. He told me to appeal and told me not to expedite it, because that wouldn’t work in my favor. Every human involved in this case knows what we should do. But the system is inhumane.

Elisabeth Potter MD

215,312 Aufrufe • vor 4 Monaten

My last case of 2025 and my first case of 2026 tell you everything you need to know about our healthcare system. Last week, I was scheduled to do a DIEP flap for a patient who had been waiting a long time. We had asked her insurance company if we could do the surgery in network at @Redbudsurgerycenter, where we have everything needed to safely and efficiently take care of her. They hadn’t approved that, so the surgery had to be scheduled at an older hospital in town. When we arrived, the hospital was having HVAC issues. The humidity levels were not safe for surgery. We waited for hours, and ultimately the case had to be canceled. It wasn’t just her surgery. Multiple surgeries were canceled that day because operating under those conditions would have been a fire risk. We weren’t able to reschedule her surgery before the end of the year, which means her deductible resets. I could have safely done her surgery at Redbud that day but insurance rules wouldn’t allow it. This is what closed networks and rigid systems look like in real life. Now here’s the contrast. The first case I’m doing in 2026 is also a woman who needs breast reconstruction with DIEP flaps. This time, instead of traditional insurance, her employer uses a third party administrator. They came to me directly and asked what I would charge if they paid fairly and transparently. On Monday, we’re doing her bilateral DIEP flap at @Redbudsurgerycenter. I can control the environment, the costs, and the care. It’s better for the patient and significantly less expensive for the employer. This is called Direct Specialty Care. It’s not direct primary care. It’s specialty care delivered without unnecessary barriers. It’s happening. We’re starting the year this way. And I’m going to keep pushing the boundaries and keeping you informed.
2:54

My last case of 2025 and my first case of 2026 tell you everything you need to know about our healthcare system. Last week, I was scheduled to do a DIEP flap for a patient who had been waiting a long time. We had asked her insurance company if we could do the surgery in network at @Redbudsurgerycenter, where we have everything needed to safely and efficiently take care of her. They hadn’t approved that, so the surgery had to be scheduled at an older hospital in town. When we arrived, the hospital was having HVAC issues. The humidity levels were not safe for surgery. We waited for hours, and ultimately the case had to be canceled. It wasn’t just her surgery. Multiple surgeries were canceled that day because operating under those conditions would have been a fire risk. We weren’t able to reschedule her surgery before the end of the year, which means her deductible resets. I could have safely done her surgery at Redbud that day but insurance rules wouldn’t allow it. This is what closed networks and rigid systems look like in real life. Now here’s the contrast. The first case I’m doing in 2026 is also a woman who needs breast reconstruction with DIEP flaps. This time, instead of traditional insurance, her employer uses a third party administrator. They came to me directly and asked what I would charge if they paid fairly and transparently. On Monday, we’re doing her bilateral DIEP flap at @Redbudsurgerycenter. I can control the environment, the costs, and the care. It’s better for the patient and significantly less expensive for the employer. This is called Direct Specialty Care. It’s not direct primary care. It’s specialty care delivered without unnecessary barriers. It’s happening. We’re starting the year this way. And I’m going to keep pushing the boundaries and keeping you informed.

Elisabeth Potter MD

136,464 Aufrufe • vor 7 Monaten

Two insurers. Two approvals. Neither happened quickly. This approval took weeks of work. Calls and emails from my team. Patients advocating for themselves. And peer to peer conversations that I now record (The reviewer is notified before we speak) In this call, I am explaining why a patient’s surgery could not safely happen at the facilities her insurance preferred. One hospital has ongoing HVAC failures. Operating rooms cannot maintain safe humidity levels. Surgeries have been canceled repeatedly since December 30. Another in network hospital was not equipped to care for a DIEP flap patient. The surgical and recovery teams were unfamiliar with the procedure and the monitoring required. The patient experienced unsafe care and asked to be discharged. I have a facility designed specifically for microsurgical breast reconstruction. It is safe. It is staffed appropriately. And I am asking for an exception so I can take care of my patient without putting her at risk. This is what peer to peer calls are supposed to be. A physician explaining patient safety. Not negotiating harm.
2:26

Two insurers. Two approvals. Neither happened quickly. This approval took weeks of work. Calls and emails from my team. Patients advocating for themselves. And peer to peer conversations that I now record (The reviewer is notified before we speak) In this call, I am explaining why a patient’s surgery could not safely happen at the facilities her insurance preferred. One hospital has ongoing HVAC failures. Operating rooms cannot maintain safe humidity levels. Surgeries have been canceled repeatedly since December 30. Another in network hospital was not equipped to care for a DIEP flap patient. The surgical and recovery teams were unfamiliar with the procedure and the monitoring required. The patient experienced unsafe care and asked to be discharged. I have a facility designed specifically for microsurgical breast reconstruction. It is safe. It is staffed appropriately. And I am asking for an exception so I can take care of my patient without putting her at risk. This is what peer to peer calls are supposed to be. A physician explaining patient safety. Not negotiating harm.

Elisabeth Potter MD

12,312 Aufrufe • vor 6 Monaten

I’m fighting every day to take care of patients at @redbudsurgerycenter and work with insurance. We’re doing complex DIEP flap reconstruction safely in an outpatient setting with incredible outcomes. When I’m not in-network yet, we use a gap exception → insurance agrees to cover the surgery at in-network rates. For one patient, we got the approval. Everything documented. We took her to surgery… and while we were in the operating room, they sent an email reversing the coverage in real time. We still took care of her, of course. But how is this allowed? How can doctors keep their doors open when billion-dollar companies can change the rules after the work is done?
1:05

I’m fighting every day to take care of patients at @redbudsurgerycenter and work with insurance. We’re doing complex DIEP flap reconstruction safely in an outpatient setting with incredible outcomes. When I’m not in-network yet, we use a gap exception → insurance agrees to cover the surgery at in-network rates. For one patient, we got the approval. Everything documented. We took her to surgery… and while we were in the operating room, they sent an email reversing the coverage in real time. We still took care of her, of course. But how is this allowed? How can doctors keep their doors open when billion-dollar companies can change the rules after the work is done?

Elisabeth Potter MD

12,010 Aufrufe • vor 4 Monaten

🚨Neurosurgeon at UCLA dealing with a patient that suffers brain tumors UnitedHealthcare has denied his patient a MRI for lifesaving imaging!! “So UnitedHealthcare has once again disappointed me as an insurance company because they not only denied an MRI for one of my patients that needed advanced sequences for tumor surgery, but they denied a peer to peer. "Now, I thought things were supposed to get better after all the complaints on social media, the heat that they've had from all the public opinion. But to take away the peer to peer process and have us fill out a form that they're going to fax to us at some unknown time and date, this patient literally needs the SARI so that we can do a safer brain tumor surgery, and yet now they're removing the avenues through which we can even apply for that." "UnitedHealth, if you are going to deny our ability to order scans or labs that are crucial for carrying out safe patient care, at least make the appeal process easier so that we can do so”
1:11

🚨Neurosurgeon at UCLA dealing with a patient that suffers brain tumors UnitedHealthcare has denied his patient a MRI for lifesaving imaging!! “So UnitedHealthcare has once again disappointed me as an insurance company because they not only denied an MRI for one of my patients that needed advanced sequences for tumor surgery, but they denied a peer to peer. "Now, I thought things were supposed to get better after all the complaints on social media, the heat that they've had from all the public opinion. But to take away the peer to peer process and have us fill out a form that they're going to fax to us at some unknown time and date, this patient literally needs the SARI so that we can do a safer brain tumor surgery, and yet now they're removing the avenues through which we can even apply for that." "UnitedHealth, if you are going to deny our ability to order scans or labs that are crucial for carrying out safe patient care, at least make the appeal process easier so that we can do so”

Wall Street Mav

34,029 Aufrufe • vor 11 Monaten

Anti competitive practices are harming patients in Austin right now and I am asking Congress for help. Insurance companies decide where my patients are permitted to have surgery. They have refused to recognize my surgery center @redbudsurgerycenter as in network, even though it is fully certified by CMS, meets all safety standards, and is often a safer environment for complex cancer surgeries. My ask to Congress is simple. Allow doctors and patients to choose where surgery is performed. Pre existing arrangements that force care into specific facilities are anti competitive and not in the best interest of patients. This week my breast cancer patients needed surgery and were unable to receive care because of insurance. Cancer does not wait. If we want to talk about cracking down on insurance company practices, this is the place to start. What you can do right now: - Call your insurance company and ask for Redbud Surgery Center to be considered in network so we can take care of our patients. -Call your member of Congress and ask them to require insurance companies to allow doctors and patients to choose the facility where care is delivered, especially when patient safety is at risk. This is how change starts 💪
2:38

Anti competitive practices are harming patients in Austin right now and I am asking Congress for help. Insurance companies decide where my patients are permitted to have surgery. They have refused to recognize my surgery center @redbudsurgerycenter as in network, even though it is fully certified by CMS, meets all safety standards, and is often a safer environment for complex cancer surgeries. My ask to Congress is simple. Allow doctors and patients to choose where surgery is performed. Pre existing arrangements that force care into specific facilities are anti competitive and not in the best interest of patients. This week my breast cancer patients needed surgery and were unable to receive care because of insurance. Cancer does not wait. If we want to talk about cracking down on insurance company practices, this is the place to start. What you can do right now: - Call your insurance company and ask for Redbud Surgery Center to be considered in network so we can take care of our patients. -Call your member of Congress and ask them to require insurance companies to allow doctors and patients to choose the facility where care is delivered, especially when patient safety is at risk. This is how change starts 💪

Elisabeth Potter MD

17,060 Aufrufe • vor 6 Monaten

Access to breast reconstruction is being denied because of poor reimbursement—and it’s a problem we need to address. Today, I saw a 69-year-old patient who was told she couldn’t get a DIEP flap because Medicare doesn’t pay enough. I hear this over and over. The reality is, CMS reimbursement sets the standard for everyone else, and when it undervalues modern breast reconstruction, patients lose access. I’ll still do the right thing for my patients, and perform their surgeries, even when I lose money—but this system needs to change. It’s time for CMS and this administration to take a hard look at how reimbursements are set. We need a new system that values patient care over profit margins. I’ll keep fighting for that, who else is with me? 💙
2:25

Access to breast reconstruction is being denied because of poor reimbursement—and it’s a problem we need to address. Today, I saw a 69-year-old patient who was told she couldn’t get a DIEP flap because Medicare doesn’t pay enough. I hear this over and over. The reality is, CMS reimbursement sets the standard for everyone else, and when it undervalues modern breast reconstruction, patients lose access. I’ll still do the right thing for my patients, and perform their surgeries, even when I lose money—but this system needs to change. It’s time for CMS and this administration to take a hard look at how reimbursements are set. We need a new system that values patient care over profit margins. I’ll keep fighting for that, who else is with me? 💙

Elisabeth Potter MD

10,467 Aufrufe • vor 1 Jahr

Kevin Costner said he didn’t want to speak publicly after Whitney Houston died because he felt their relationship was “just a movie.” Kevin Costner: What happened was, it was a thing I didn't want to do. When Whitney passed, the microphone was going around for a, for a week, that everybody getting on TV talking about her. And I'm thinking, "Jesus, the last thing I want to do is get on a radio and talk about her." Uh, after all, it was just a movie really. And, but there was this weird thing that I didn't take into consideration. I think sometimes, maybe you and I can miss what the real momentum is, that we don't really gauge it because we either intellectually dismiss it or we just don't care, but people wanted to hear what I had to say about her, which baffled me. It was a, it was a make-believe relationship we had. And so I avoided it.
2:49

Kevin Costner said he didn’t want to speak publicly after Whitney Houston died because he felt their relationship was “just a movie.” Kevin Costner: What happened was, it was a thing I didn't want to do. When Whitney passed, the microphone was going around for a, for a week, that everybody getting on TV talking about her. And I'm thinking, "Jesus, the last thing I want to do is get on a radio and talk about her." Uh, after all, it was just a movie really. And, but there was this weird thing that I didn't take into consideration. I think sometimes, maybe you and I can miss what the real momentum is, that we don't really gauge it because we either intellectually dismiss it or we just don't care, but people wanted to hear what I had to say about her, which baffled me. It was a, it was a make-believe relationship we had. And so I avoided it.

Ruzy.hl

4,369,036 Aufrufe • vor 1 Monat

I’ll never forget how pissed Spo was after game 6 and told the media the Heat will win the series in Boston: “It’s the way this season has been, this is one hell of a series. At this time right now I don’t know how we’re going to get this done but we’re going to go up there (Boston) and get it done…there’s been nothing easy about this season for our group so we just have to do it the hard way…we wish we can tip this thing off right now, RIGHT NOW! We want to tip this thing off and we play another 48 minutes…” What crazy time to be a fan.
0:43

I’ll never forget how pissed Spo was after game 6 and told the media the Heat will win the series in Boston: “It’s the way this season has been, this is one hell of a series. At this time right now I don’t know how we’re going to get this done but we’re going to go up there (Boston) and get it done…there’s been nothing easy about this season for our group so we just have to do it the hard way…we wish we can tip this thing off right now, RIGHT NOW! We want to tip this thing off and we play another 48 minutes…” What crazy time to be a fan.

The HEAT Realm

283,850 Aufrufe • vor 3 Monaten

"At school or university, the thing is to be brilliant and to get the answer right first time. And there are brilliant people who can do that, but for the rest of us, we're not brilliant. And to get there, we have to strive and we have to go through failure. And we realize that you don't get it right first time, you don't get it right second time. In my case, and I counted it, it's 5,127 times. One of the things I always want to say is that sounds like a struggle. It was a struggle, but actually it was a hugely enjoyable struggle. The debt was mounting and I had three children, a wife and a home, and then a mortgage to pay, like everybody else. But I had a real point in life, I had a real aim and I had to get there. And the failures were interesting because I'd learned from every single one of them."
0:51

"At school or university, the thing is to be brilliant and to get the answer right first time. And there are brilliant people who can do that, but for the rest of us, we're not brilliant. And to get there, we have to strive and we have to go through failure. And we realize that you don't get it right first time, you don't get it right second time. In my case, and I counted it, it's 5,127 times. One of the things I always want to say is that sounds like a struggle. It was a struggle, but actually it was a hugely enjoyable struggle. The debt was mounting and I had three children, a wife and a home, and then a mortgage to pay, like everybody else. But I had a real point in life, I had a real aim and I had to get there. And the failures were interesting because I'd learned from every single one of them."

David Senra

137,546 Aufrufe • vor 8 Monaten

Board Certified OBGYN exposes what they must go through just to get one prescription approved by health insurance companies “This is what doctors are dealing with in 2025. So my patient needs a medication, an indicated medication for her condition. So I send the prescription to the commercial pharmacy - The pharmacist tells me that this medication needs a prior authorization and sends me a fax with a 1-800 number - The 1-800 number leads me to a pharmacy benefit manager that wants to ask my npi, my date of birth, the patient's information, what kind of the prescription is, how long do they need it for. Only to tell me at the end of the phone call that I actually have to call the patient's insurance company to authorize the prior authorization for the needed medication - So I call the patient's insurance company and once again, I have to verify my information, the patient's information, the prescription information, what the patient needs it for, only for the insurance company to tell me that this is not how they do prior authorization - So they're going to have to fax me some forms that I'm not allowed to do a prior authorization on the phone - So then the fax comes through and I fill it all out. The patient's information, my information, my npi, what the prescription is, how long they need it for, clinical documentation. And now we sit and wait and see if the powers that be think that the patient actually needs the medication” “I went to school. I went to undergraduate medical school, 4 years of OBGYN residency, then went back and did an integrative medicine fellowship, all for these people to dictate how my patient gets cared for. Please know that your healthcare providers are fighting for you day in and day out on things we don't get reimbursed for.” US Healthcare Insurance executives need to be thrown in prison for what they’ve done to our healthcare system
1:35

Board Certified OBGYN exposes what they must go through just to get one prescription approved by health insurance companies “This is what doctors are dealing with in 2025. So my patient needs a medication, an indicated medication for her condition. So I send the prescription to the commercial pharmacy - The pharmacist tells me that this medication needs a prior authorization and sends me a fax with a 1-800 number - The 1-800 number leads me to a pharmacy benefit manager that wants to ask my npi, my date of birth, the patient's information, what kind of the prescription is, how long do they need it for. Only to tell me at the end of the phone call that I actually have to call the patient's insurance company to authorize the prior authorization for the needed medication - So I call the patient's insurance company and once again, I have to verify my information, the patient's information, the prescription information, what the patient needs it for, only for the insurance company to tell me that this is not how they do prior authorization - So they're going to have to fax me some forms that I'm not allowed to do a prior authorization on the phone - So then the fax comes through and I fill it all out. The patient's information, my information, my npi, what the prescription is, how long they need it for, clinical documentation. And now we sit and wait and see if the powers that be think that the patient actually needs the medication” “I went to school. I went to undergraduate medical school, 4 years of OBGYN residency, then went back and did an integrative medicine fellowship, all for these people to dictate how my patient gets cared for. Please know that your healthcare providers are fighting for you day in and day out on things we don't get reimbursed for.” US Healthcare Insurance executives need to be thrown in prison for what they’ve done to our healthcare system

Wall Street Apes

415,111 Aufrufe • vor 1 Jahr

Today was one of those days that reminds me exactly why this work matters. We cared for a 36-year-old woman who’s been fighting breast cancer—chemo, mastectomy, all of it—while working in a job where time off is hard to come by. She came to see me in tears, worried that rising insurance premiums meant she wouldn’t be able to afford her care if we waited until the new year. So we didn’t wait. We got approval, we moved quickly, and we took care of her. She now has symmetry, time to heal during the holidays, and one less thing weighing on her shoulders. I know many patients are feeling this same fear right now. And I want you to know this: I’m not okay with a system that puts people in this position. We can’t keep pouring money into something that isn’t working. We can do better—and we have to. I’ll keep showing up, speaking up, and doing everything I can to make sure patients get the care they need, when they need it.
1:31

Today was one of those days that reminds me exactly why this work matters. We cared for a 36-year-old woman who’s been fighting breast cancer—chemo, mastectomy, all of it—while working in a job where time off is hard to come by. She came to see me in tears, worried that rising insurance premiums meant she wouldn’t be able to afford her care if we waited until the new year. So we didn’t wait. We got approval, we moved quickly, and we took care of her. She now has symmetry, time to heal during the holidays, and one less thing weighing on her shoulders. I know many patients are feeling this same fear right now. And I want you to know this: I’m not okay with a system that puts people in this position. We can’t keep pouring money into something that isn’t working. We can do better—and we have to. I’ll keep showing up, speaking up, and doing everything I can to make sure patients get the care they need, when they need it.

Elisabeth Potter MD

46,308 Aufrufe • vor 7 Monaten

I got a call from insurance asking me to justify why my patient—who had a bilateral mastectomy and DIEP flap reconstruction—needed to stay in the hospital for two days. For context: ✅ She had bilateral mastectomies. ✅ She had complex microsurgery (DIEP flaps). ✅ She required continuous blood-flow monitoring with specialized Vioptix. ✅ Written approval from UnitedHealthcare dated July 17. And yet, AFTER surgery, during clinic, I was told I had to do a same-day “peer-to-peer.” I did not request this call. I was exhausted after seeing 65 patients in two days and heading to the hospital to care for the patient I posted about last week (the MRI/expander case). The physician on the line was polite but said the state of Texas required her to call, and she either (1) didn’t know authorization had already been granted or (2) didn’t have access to the medical records that would have answered the question. This was approved because my staff is incredible. As soon as Ebonie heard I was being pulled into a last-minute review, she printed the approval letter and put it in my hand while I was still in clinic. That’s what it takes to practice medicine right now. This is what we mean by insurance interrupting care. Instead of focusing on healing, teams are pulled off the floor to re-prove the obvious and re-justify decisions already authorized. I would like you to ask yourself: — Is this system helping us care for patients or wearing us down? — Why am I forced to ask permission to do the right thing, repeatedly, and then defend it after the fact? Patients deserve monitoring and support after a surgery of this magnitude. They deserve our full attention not red tape.
2:49

I got a call from insurance asking me to justify why my patient—who had a bilateral mastectomy and DIEP flap reconstruction—needed to stay in the hospital for two days. For context: ✅ She had bilateral mastectomies. ✅ She had complex microsurgery (DIEP flaps). ✅ She required continuous blood-flow monitoring with specialized Vioptix. ✅ Written approval from UnitedHealthcare dated July 17. And yet, AFTER surgery, during clinic, I was told I had to do a same-day “peer-to-peer.” I did not request this call. I was exhausted after seeing 65 patients in two days and heading to the hospital to care for the patient I posted about last week (the MRI/expander case). The physician on the line was polite but said the state of Texas required her to call, and she either (1) didn’t know authorization had already been granted or (2) didn’t have access to the medical records that would have answered the question. This was approved because my staff is incredible. As soon as Ebonie heard I was being pulled into a last-minute review, she printed the approval letter and put it in my hand while I was still in clinic. That’s what it takes to practice medicine right now. This is what we mean by insurance interrupting care. Instead of focusing on healing, teams are pulled off the floor to re-prove the obvious and re-justify decisions already authorized. I would like you to ask yourself: — Is this system helping us care for patients or wearing us down? — Why am I forced to ask permission to do the right thing, repeatedly, and then defend it after the fact? Patients deserve monitoring and support after a surgery of this magnitude. They deserve our full attention not red tape.

Elisabeth Potter MD

20,697 Aufrufe • vor 11 Monaten

NEW: Video showing how the NHS Federated Data Platform is providing clinicians and administrators with real-time data to accelerate treatment and improve patient care at North Cumbria Integrated Care NHS Foundation Trust. 📣 “We’re maximising patient safety. We’re maximising the efficiency with which we move patients through the pathways, so they get their treatment as fast as possible without undue delay.” 📣 ”We started off with 12 patients an hour. And now we’ve got people doing 45 patients, which is more than ever. The most important thing for us now is - we actually know how many true waiters we have. We didn’t know that before.” Great to hear such positive feedback from NHS staff on the ground at North Cumbria Integrated Care NHS Foundation Trust.
2:23

NEW: Video showing how the NHS Federated Data Platform is providing clinicians and administrators with real-time data to accelerate treatment and improve patient care at North Cumbria Integrated Care NHS Foundation Trust. 📣 “We’re maximising patient safety. We’re maximising the efficiency with which we move patients through the pathways, so they get their treatment as fast as possible without undue delay.” 📣 ”We started off with 12 patients an hour. And now we’ve got people doing 45 patients, which is more than ever. The most important thing for us now is - we actually know how many true waiters we have. We didn’t know that before.” Great to hear such positive feedback from NHS staff on the ground at North Cumbria Integrated Care NHS Foundation Trust.

Louis Mosley

23,539 Aufrufe • vor 1 Jahr

EXTREMELY IMPORTANT 🚨 American Surgeon just recorded her peer-to-peer phone call with an insurance company and they admit they have “Planned denials” She plays the recording in this clip, THIS IS CRIMINAL “I think we've all suspected that that's what's going on. But to hear him say that, that some of these denials are, you know, they're planned, it's already set in stone, and they're just going through the motions with the peer to peer, that was eye opening. And I think that term planned denial is something that is probably used internally in insurance companies, but rarely with doctors and patients. So the planned denial sounds like they've already decided, it's denied, and that's it.”
0:44

EXTREMELY IMPORTANT 🚨 American Surgeon just recorded her peer-to-peer phone call with an insurance company and they admit they have “Planned denials” She plays the recording in this clip, THIS IS CRIMINAL “I think we've all suspected that that's what's going on. But to hear him say that, that some of these denials are, you know, they're planned, it's already set in stone, and they're just going through the motions with the peer to peer, that was eye opening. And I think that term planned denial is something that is probably used internally in insurance companies, but rarely with doctors and patients. So the planned denial sounds like they've already decided, it's denied, and that's it.”

Wall Street Apes

761,358 Aufrufe • vor 1 Jahr

EVERYONE NEEDS TO SEE THIS 🚨 American doctor exposes new internal change to Blue Cross prior authorization process to deny coverage for Americans - They’ll only speak to the doctor who put in request - They WONT SAY WHAT NUMBER THEY’RE CALLING FROM - They’ll ONLY CALL ONCE - If they miss the call, the patient will be denied coverage for treatment “Now Blue Cross is saying that they will only do their peer to peer reviews by calling the doctor who is asking for the treatment to be authorized. And they will only call once, and they won't tell you when they're calling, and they won't tell you what number they're calling from.” “So if you're a doctor seeing patients and you have your phone on do not disturb because you're seeing patients or you just don't answer numbers that you don't recognize, and you're seeing patients and you don't wanna interrupt a a patient visit, you're gonna miss the call. And guess what? The treatment will not be authorized” “They're getting more creative about how to deny your claims or just not authorize your treatment at all. I'm going on information given to me by Blue Cross. I am a physician. When we physicians ask for a treatment to be authorized by an insurance company and they deny authorization, what happens at that point is that we are asked to do a peer to peer review, meaning that we, the doctor asking for the treatment, have to speak with the doctor who is employed by the insurance company, who is there only to say no.” THIS IS INSANE
1:51

EVERYONE NEEDS TO SEE THIS 🚨 American doctor exposes new internal change to Blue Cross prior authorization process to deny coverage for Americans - They’ll only speak to the doctor who put in request - They WONT SAY WHAT NUMBER THEY’RE CALLING FROM - They’ll ONLY CALL ONCE - If they miss the call, the patient will be denied coverage for treatment “Now Blue Cross is saying that they will only do their peer to peer reviews by calling the doctor who is asking for the treatment to be authorized. And they will only call once, and they won't tell you when they're calling, and they won't tell you what number they're calling from.” “So if you're a doctor seeing patients and you have your phone on do not disturb because you're seeing patients or you just don't answer numbers that you don't recognize, and you're seeing patients and you don't wanna interrupt a a patient visit, you're gonna miss the call. And guess what? The treatment will not be authorized” “They're getting more creative about how to deny your claims or just not authorize your treatment at all. I'm going on information given to me by Blue Cross. I am a physician. When we physicians ask for a treatment to be authorized by an insurance company and they deny authorization, what happens at that point is that we are asked to do a peer to peer review, meaning that we, the doctor asking for the treatment, have to speak with the doctor who is employed by the insurance company, who is there only to say no.” THIS IS INSANE

Wall Street Apes

1,465,616 Aufrufe • vor 1 Jahr