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It’s 2025, and navigating insurance has somehow gotten even WORSE! -Performed two bilateral DIEP flap surgeries and two bilateral tissue expander surgeries today -During one DIEP case, while the patient was already asleep, United Healthcare called demanding diagnosis and inpatient stay justification "Had to scrub out mid-surgery to take... show more

Wall Street Mav

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29,761 views • 11 months ago •via X (Twitter)

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Dr. Caleb Masterson say health insurance companies are openly breaking laws in Alabama He explains some of his patients situations with insurance companies - “I had an insurance company tell a patient that no authorization for the procedure was required, the procedure was performed, and then the patient was denied the care because the procedure was never authorized. So the patient got charged the entire cost of the procedure” - “I had another patient who is supposed to be due an answer to an insurance claim within 30 days of submission. If they do not reply within 30 days, that's breaking Alabama law. And that claim is currently at the 65th day, so its insurance can be breaking the law.” - “Then I had an insurance company deny care to a patient that they had previously approved. So a patient qualified for surgery based on medical necessity, they had met all the criteria for surgery, they underwent surgery, then the patient had that surgery denied. The patient submitted that information to the insurance company and said, Hey, look, this was already pre-approved. And they said, We reversed our decision and the patient had to pay.”

Dr. Caleb Masterson say health insurance companies are openly breaking laws in Alabama He explains some of his patients situations with insurance companies - “I had an insurance company tell a patient that no authorization for the procedure was required, the procedure was performed, and then the patient was denied the care because the procedure was never authorized. So the patient got charged the entire cost of the procedure” - “I had another patient who is supposed to be due an answer to an insurance claim within 30 days of submission. If they do not reply within 30 days, that's breaking Alabama law. And that claim is currently at the 65th day, so its insurance can be breaking the law.” - “Then I had an insurance company deny care to a patient that they had previously approved. So a patient qualified for surgery based on medical necessity, they had met all the criteria for surgery, they underwent surgery, then the patient had that surgery denied. The patient submitted that information to the insurance company and said, Hey, look, this was already pre-approved. And they said, We reversed our decision and the patient had to pay.”

Wall Street Apes

46,070 views • 5 months ago

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.

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 views • 10 months ago

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.

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 views • 6 months ago

American Doctor filmed this video to show the American People what’s it’s like trying to get insurance to approve procedures “Nine minutes on hold and still no answers—UnitedHealthcare, are you serious? — As a doctor, it’s almost impossible to get through to someone at an insurance company” This phone call proves these calls are a runarounds TO NOWHERE, they are clearly setup to make you just give up and not even bother. THIS IS SICK The doctor posted this video and said “I recently shared a video explaining how, during a DIEP surgery, I had to scrub out mid-procedure to address a call from UnitedHealthcare demanding justification for my patient’s diagnosis and inpatient stay—despite the surgery being pre-approved. To make matters worse, the representative lacked access to the patient’s full medical information, causing unnecessary disruption. After posting the video, UnitedHealthcare actually left a message at my office with a callback number. As a doctor, it’s almost impossible to get through to someone at an insurance company, but I gave it a shot. I waited on hold for nearly 10 minutes but was ultimately unable to reach the right person (not surprising). I still don’t know what they wanted to discuss, leaving me with even more questions. Most importantly, this raises a bigger issue: What can we do to create change?”

American Doctor filmed this video to show the American People what’s it’s like trying to get insurance to approve procedures “Nine minutes on hold and still no answers—UnitedHealthcare, are you serious? — As a doctor, it’s almost impossible to get through to someone at an insurance company” This phone call proves these calls are a runarounds TO NOWHERE, they are clearly setup to make you just give up and not even bother. THIS IS SICK The doctor posted this video and said “I recently shared a video explaining how, during a DIEP surgery, I had to scrub out mid-procedure to address a call from UnitedHealthcare demanding justification for my patient’s diagnosis and inpatient stay—despite the surgery being pre-approved. To make matters worse, the representative lacked access to the patient’s full medical information, causing unnecessary disruption. After posting the video, UnitedHealthcare actually left a message at my office with a callback number. As a doctor, it’s almost impossible to get through to someone at an insurance company, but I gave it a shot. I waited on hold for nearly 10 minutes but was ultimately unable to reach the right person (not surprising). I still don’t know what they wanted to discuss, leaving me with even more questions. Most importantly, this raises a bigger issue: What can we do to create change?”

Wall Street Apes

132,043 views • 1 year ago

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.

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 views • 5 months ago

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.”

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 views • 1 year ago

It is 2026 and healthcare is still not making any common sense. Today, multiple cases were canceled again because of a facility issue. The operating rooms weren’t safe to operate in. So my breast cancer patients had their surgeries delayed for hours, and one had to be moved to another facility tomorrow. And what’s so frustrating is that I have an operating room I could take these cases to. It’s ready. It’s safe. But because insurance companies get to decide where we’re allowed to operate, I couldn’t use it. In this case, it was United. They haven’t approved me to be in network at my surgery center, so even though the OR was available, I wasn’t allowed to move the cases there. Other insurance companies have contracted and allow me to take care of patients there. So today, a patient didn’t get surgery when she could have.

It is 2026 and healthcare is still not making any common sense. Today, multiple cases were canceled again because of a facility issue. The operating rooms weren’t safe to operate in. So my breast cancer patients had their surgeries delayed for hours, and one had to be moved to another facility tomorrow. And what’s so frustrating is that I have an operating room I could take these cases to. It’s ready. It’s safe. But because insurance companies get to decide where we’re allowed to operate, I couldn’t use it. In this case, it was United. They haven’t approved me to be in network at my surgery center, so even though the OR was available, I wasn’t allowed to move the cases there. Other insurance companies have contracted and allow me to take care of patients there. So today, a patient didn’t get surgery when she could have.

Elisabeth Potter MD

53,161 views • 6 months ago

Insurance ≠ Access Today, I performed a breast reduction for a patient who had been searching for FOUR YEARS for a plastic surgeon who would take her insurance. She met all the medical criteria, but her insurance company only reimbursed $1,000 for the procedure—when the average cost is $7,800 and in Austin, it's often $13,000+. This is the reality of healthcare today: Insurance coverage doesn’t guarantee access. When reimbursement rates are too low, surgeons simply can’t afford to take these cases. The cost of running a practice is rising, while insurance payments are declining. I want to help. I want to offer these surgeries through insurance for my patients. But the system is making it impossible.

Insurance ≠ Access Today, I performed a breast reduction for a patient who had been searching for FOUR YEARS for a plastic surgeon who would take her insurance. She met all the medical criteria, but her insurance company only reimbursed $1,000 for the procedure—when the average cost is $7,800 and in Austin, it's often $13,000+. This is the reality of healthcare today: Insurance coverage doesn’t guarantee access. When reimbursement rates are too low, surgeons simply can’t afford to take these cases. The cost of running a practice is rising, while insurance payments are declining. I want to help. I want to offer these surgeries through insurance for my patients. But the system is making it impossible.

Elisabeth Potter MD

116,212 views • 1 year ago

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 💪

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 views • 6 months ago

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? 💙

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

10,439 views • 1 year ago

Nine minutes on hold and still no answers—UnitedHealthcare, are you serious? UnitedHealthcare called me mid-surgery because they wanted justification for my patient’s diagnosis and inpatient stay—despite the surgery already being pre-approved. Worse? The rep didn’t even have full access to my patient's medical info. After posting about it, United left a message at my office with a callback number. As a doctor, it’s nearly impossible to get through to someone at an insurance company, but I gave it a shot. ⏳I waited on hold for nearly 10 minutes—only to reach no one. I still don’t know what they wanted to discuss. This isn’t just frustrating—it’s broken. 🚨How do we change this?

Nine minutes on hold and still no answers—UnitedHealthcare, are you serious? UnitedHealthcare called me mid-surgery because they wanted justification for my patient’s diagnosis and inpatient stay—despite the surgery already being pre-approved. Worse? The rep didn’t even have full access to my patient's medical info. After posting about it, United left a message at my office with a callback number. As a doctor, it’s nearly impossible to get through to someone at an insurance company, but I gave it a shot. ⏳I waited on hold for nearly 10 minutes—only to reach no one. I still don’t know what they wanted to discuss. This isn’t just frustrating—it’s broken. 🚨How do we change this?

Elisabeth Potter MD

203,796 views • 1 year ago

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?

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 views • 4 months ago

Where Is the Money Going? On a recent morning, we walked into my patient’s hospital room on rounds. She was recovering from breast reconstruction with bilateral DIEPs after cancer. And there was sewage coming up through the floor of her shower. The hardworking nurses who are so used to making difficult situations work, were adjusting and working around it. A safety cone was placed in the bathroom door and a bedside commode had been brought into the room. No one was surprised. I want to know where the money is going. We’re all paying insurance premiums. Hospitals are charging enormous amounts. Reimbursement rates for complex surgeries like DIEP flap reconstruction keep getting slashed. And yet…this is happening. Healthcare is becoming more expensive, harder to access, and patients are paying the price—literally. We all deserve answers💙

Where Is the Money Going? On a recent morning, we walked into my patient’s hospital room on rounds. She was recovering from breast reconstruction with bilateral DIEPs after cancer. And there was sewage coming up through the floor of her shower. The hardworking nurses who are so used to making difficult situations work, were adjusting and working around it. A safety cone was placed in the bathroom door and a bedside commode had been brought into the room. No one was surprised. I want to know where the money is going. We’re all paying insurance premiums. Hospitals are charging enormous amounts. Reimbursement rates for complex surgeries like DIEP flap reconstruction keep getting slashed. And yet…this is happening. Healthcare is becoming more expensive, harder to access, and patients are paying the price—literally. We all deserve answers💙

Elisabeth Potter MD

51,538 views • 1 year ago

American Surgeon talking about US Health Insurance Companies denying coverage for patients in extreme need “Today, this patient was actually denied surgery initially, and he has spinal cord compression. He has spinal nerve compression, he has severe weakness, and he has a collapsed neck. So these are the challenges that we have every day. So to get patients to the OR takes a lot of people.” He then talks about how many people it actually takes just to overcome insurance company denies and get their patients care, “We battle this all the time.” “A patient who has a clear indication for surgery denied by the insurance company, - First they denied the surgery altogether - Then they said that I couldn't use cages to support the spine - Then they said I could do a three level fusion without a plate - Then they said the patient had to go home on the same day of surgery, which I think is, is actually dangerous” This video is crazy, the insurance company actually wants to leave patients in extremely dangerous situations even after surgery

American Surgeon talking about US Health Insurance Companies denying coverage for patients in extreme need “Today, this patient was actually denied surgery initially, and he has spinal cord compression. He has spinal nerve compression, he has severe weakness, and he has a collapsed neck. So these are the challenges that we have every day. So to get patients to the OR takes a lot of people.” He then talks about how many people it actually takes just to overcome insurance company denies and get their patients care, “We battle this all the time.” “A patient who has a clear indication for surgery denied by the insurance company, - First they denied the surgery altogether - Then they said that I couldn't use cages to support the spine - Then they said I could do a three level fusion without a plate - Then they said the patient had to go home on the same day of surgery, which I think is, is actually dangerous” This video is crazy, the insurance company actually wants to leave patients in extremely dangerous situations even after surgery

Wall Street Apes

1,189,864 views • 1 year ago

A surgery was canceled on December 30 because the operating rooms weren’t safe. Weeks later, I’m still trying to get it rescheduled. This patient needs breast reconstruction. The same hospital that canceled her surgery continues to have safety issues. They canceled surgeries again today. So I’m trying to move her surgery to our surgery center, where the operating rooms are safe and the team is built for this exact work. It’s mid January and I still can’t get it scheduled. Now her insurance says I can do a peer to peer call on January 20. I’ll take the call. I’ll explain, again, why our surgery center is the safer place to do this operation. But here’s the part that matters. Why does a patient who needs covered, medically appropriate breast reconstruction have to wait weeks while a doctor makes a case to an insurance company? I’m a surgeon. The surgery is covered. The facility is safe. This patient deserves care. I’ll keep you posted after the peer to peer.

A surgery was canceled on December 30 because the operating rooms weren’t safe. Weeks later, I’m still trying to get it rescheduled. This patient needs breast reconstruction. The same hospital that canceled her surgery continues to have safety issues. They canceled surgeries again today. So I’m trying to move her surgery to our surgery center, where the operating rooms are safe and the team is built for this exact work. It’s mid January and I still can’t get it scheduled. Now her insurance says I can do a peer to peer call on January 20. I’ll take the call. I’ll explain, again, why our surgery center is the safer place to do this operation. But here’s the part that matters. Why does a patient who needs covered, medically appropriate breast reconstruction have to wait weeks while a doctor makes a case to an insurance company? I’m a surgeon. The surgery is covered. The facility is safe. This patient deserves care. I’ll keep you posted after the peer to peer.

Elisabeth Potter MD

11,553 views • 6 months ago

US Health Insurance companies are out of control Surgeon Dr Elisabeth Potter submitted for one of her patients to have surgery at a particular outpatient center Without asking her or the patient, the insurance company called a cheaper hospital, asked if they had availability, and then scheduled her patient at that hospital to have Dr Potter do the surgery there instead of at the preferred center “This is insane. The patient doesn't want her surgery in a hospital. I know that she'll have a better experience and outcome at Redbud Surgery Center. They're calling the scheduling office of the hospital and questioning my plan and telling me what to do I can't explain how absurd this feels. I'm making a recommendation for my patient based on what I think is best for her. She's choosing where she wants to have her surgery, and the insurance company is going behind both of us and trying to make us do something different” This is what happens when health insurance companies aren’t ever regulated, they just keep getting worse and worse “The overreach by insurance companies is next level”

US Health Insurance companies are out of control Surgeon Dr Elisabeth Potter submitted for one of her patients to have surgery at a particular outpatient center Without asking her or the patient, the insurance company called a cheaper hospital, asked if they had availability, and then scheduled her patient at that hospital to have Dr Potter do the surgery there instead of at the preferred center “This is insane. The patient doesn't want her surgery in a hospital. I know that she'll have a better experience and outcome at Redbud Surgery Center. They're calling the scheduling office of the hospital and questioning my plan and telling me what to do I can't explain how absurd this feels. I'm making a recommendation for my patient based on what I think is best for her. She's choosing where she wants to have her surgery, and the insurance company is going behind both of us and trying to make us do something different” This is what happens when health insurance companies aren’t ever regulated, they just keep getting worse and worse “The overreach by insurance companies is next level”

Wall Street Apes

40,462 views • 3 months ago

American Surgeon shows the actual letter from UnitedHealthcare DENYING a patient in emergency condition from receiving care “This is a woman who was in the emergency room with pulmonary embolisms” “I think we all knew this would happen. I had another patient come in and share with me that UnitedHealthcare denied her inpatient's day. So this is a patient who had shortness of breath and some chest pain, and she just knew that something wasn't right in her body. She had a family history of blood clots and she'd had a deep flap surgery a couple of weeks ago. She went to the hospital and they saw her and they found that she had a life threatening condition known as pulmonary embolisms. So she was admitted to the hospital and taken care of really well by the doctors there. And they ordered all the right things. After a couple of days, she was discharged. She got a letter from UnitedHealthcare explaining that they didn't agree with the level of her care and that they would not cover it. So I'm gonna share some of the language of that letter with you, and I want you to know that my patient that we talked about previously who had her surgery denied had almost exactly the same letter shared. So there's some troubling things in this letter. I think this term is really interesting. United is saying they reviewed the request for inpatient admission. So let's all just pause and consider that. This is a woman who was in the emergency room with pulmonary embolisms, and the doctor wasn't really requesting anything. They were saying this patient needs to be in the hospital. But an insurance company sees this as a request, and that's part of this prior auth environment that we're living in. So I think it's important as patients and as physicians to just acknowledge that this is our reality now. Someone can think that there's a good medical decision for you and can write orders and wanna do the right thing for you, but your insurance company is seeing that as a request and deciding whether or not they wanna do it. One of the criteria that this insurance company used to decide whether or not to accept or deny this request was whether it's medically necessary. And it's so interesting that we're letting insurance companies and the doctors who work for insurance companies determine what's medically necessary and not just the doctor in front of the patient in the emergency room. So this is a really bold statement from UnitedHealthcare for my patient. They say you did not have to be admitted as an inpatient to the hospital for this care. I think we all need to just reflect on that. An insurance company is telling a patient and her doctor that they disagree with the plan of care to keep that patient safe. I know that this is boiling down to whether it's an inpatient admission or an observation admission, and that's really about money. But what I wanna point out to you is they're making medical decisions. This insurance company is actually weighing in and disagreeing with a doctor who made a medical decision to admit this patient for her safety. So this specific sentence, when a doctor or facility treats a patient above the recommended level of care, we cannot cover it. What the heck? That's what we do. We go above and beyond as physicians. It's clear that insurance companies don't, and they're actually saying it here.”

American Surgeon shows the actual letter from UnitedHealthcare DENYING a patient in emergency condition from receiving care “This is a woman who was in the emergency room with pulmonary embolisms” “I think we all knew this would happen. I had another patient come in and share with me that UnitedHealthcare denied her inpatient's day. So this is a patient who had shortness of breath and some chest pain, and she just knew that something wasn't right in her body. She had a family history of blood clots and she'd had a deep flap surgery a couple of weeks ago. She went to the hospital and they saw her and they found that she had a life threatening condition known as pulmonary embolisms. So she was admitted to the hospital and taken care of really well by the doctors there. And they ordered all the right things. After a couple of days, she was discharged. She got a letter from UnitedHealthcare explaining that they didn't agree with the level of her care and that they would not cover it. So I'm gonna share some of the language of that letter with you, and I want you to know that my patient that we talked about previously who had her surgery denied had almost exactly the same letter shared. So there's some troubling things in this letter. I think this term is really interesting. United is saying they reviewed the request for inpatient admission. So let's all just pause and consider that. This is a woman who was in the emergency room with pulmonary embolisms, and the doctor wasn't really requesting anything. They were saying this patient needs to be in the hospital. But an insurance company sees this as a request, and that's part of this prior auth environment that we're living in. So I think it's important as patients and as physicians to just acknowledge that this is our reality now. Someone can think that there's a good medical decision for you and can write orders and wanna do the right thing for you, but your insurance company is seeing that as a request and deciding whether or not they wanna do it. One of the criteria that this insurance company used to decide whether or not to accept or deny this request was whether it's medically necessary. And it's so interesting that we're letting insurance companies and the doctors who work for insurance companies determine what's medically necessary and not just the doctor in front of the patient in the emergency room. So this is a really bold statement from UnitedHealthcare for my patient. They say you did not have to be admitted as an inpatient to the hospital for this care. I think we all need to just reflect on that. An insurance company is telling a patient and her doctor that they disagree with the plan of care to keep that patient safe. I know that this is boiling down to whether it's an inpatient admission or an observation admission, and that's really about money. But what I wanna point out to you is they're making medical decisions. This insurance company is actually weighing in and disagreeing with a doctor who made a medical decision to admit this patient for her safety. So this specific sentence, when a doctor or facility treats a patient above the recommended level of care, we cannot cover it. What the heck? That's what we do. We go above and beyond as physicians. It's clear that insurance companies don't, and they're actually saying it here.”

Wall Street Apes

115,691 views • 1 year ago

Closed networks don’t exist to help patients. They exist to make money. I saw a woman today who traveled all the way from New Mexico to Texas because her insurance network had no one who could do her DIEP flap reconstruction. She’s had breast cancer, a mastectomy, radiation, and now a painful implant that looks like it’s about to come through her skin. She’s been waiting since July for approval. Not for travel, just for the chance to see me, because her network blocked her from getting care outside their list. Closed networks limit choice, control doctors, and keep patients from the care they need. It’s time we rethink this.

Closed networks don’t exist to help patients. They exist to make money. I saw a woman today who traveled all the way from New Mexico to Texas because her insurance network had no one who could do her DIEP flap reconstruction. She’s had breast cancer, a mastectomy, radiation, and now a painful implant that looks like it’s about to come through her skin. She’s been waiting since July for approval. Not for travel, just for the chance to see me, because her network blocked her from getting care outside their list. Closed networks limit choice, control doctors, and keep patients from the care they need. It’s time we rethink this.

Elisabeth Potter MD

12,238 views • 9 months ago

Something has to change. After operating all day and doing two DIEP flap cases, I saw a woman who had driven hours across Texas to get help. She has a history of breast cancer, had implant reconstruction, and had radiation on one side. And we know this, radiation and implants don’t mix. She developed signs of infection. Her incisions opened, fluid was draining, and she went to an ER and even called her plastic surgeon for help. The surgeon who initially performed her reconstruction told her, “I don’t take your insurance anymore.” She continued working and looking for help while the infection got worse. Because her insurance reimburses so poorly, she couldn’t find someone to operate on her. Eventually, she made it to our practice where we took care of her. Our plan is to treat the infection and then perform a flap reconstruction so she can finally heal. It’s a privilege to have her trust and to take care of her. But I want to say this clearly: This level of heroic effort is not the answer longterm. We need a sustainable system that is applying pressures in the right direction. And we need to agree on what healthcare services should be available to all Americans.

Something has to change. After operating all day and doing two DIEP flap cases, I saw a woman who had driven hours across Texas to get help. She has a history of breast cancer, had implant reconstruction, and had radiation on one side. And we know this, radiation and implants don’t mix. She developed signs of infection. Her incisions opened, fluid was draining, and she went to an ER and even called her plastic surgeon for help. The surgeon who initially performed her reconstruction told her, “I don’t take your insurance anymore.” She continued working and looking for help while the infection got worse. Because her insurance reimburses so poorly, she couldn’t find someone to operate on her. Eventually, she made it to our practice where we took care of her. Our plan is to treat the infection and then perform a flap reconstruction so she can finally heal. It’s a privilege to have her trust and to take care of her. But I want to say this clearly: This level of heroic effort is not the answer longterm. We need a sustainable system that is applying pressures in the right direction. And we need to agree on what healthcare services should be available to all Americans.

Elisabeth Potter MD

43,518 views • 8 months ago

After I moved more breast reconstruction surgeries to an outpatient surgery center, the hospital proposed sending my remaining DIEP flap patients to the ICU, despite the fact that these patients had never previously required ICU care. The ICU is one of the most expensive places in a hospital. So I called hospital leadership to explain why I believed this wasn’t in the best interest of patients. I’m sharing that conversation with you. Over the past 13 years, our team has performed thousands of breast reconstruction procedures with a 99.7 % success rate. These patients do not need ICU care. They need specialized nurses who understand breast reconstruction, early mobility, and a pathway that gets them safely home. The documented rationale for the change had nothing to do with patients actually needed more acute care. It had everything to do with declining case volume. We can learn a lot about priorities by observing how people and systems respond to stress. I improved outcomes and lowered the cost of breast reconstruction by moving it to an outpatient center. The system responded by increasing the cost per patient. We should all take note.

After I moved more breast reconstruction surgeries to an outpatient surgery center, the hospital proposed sending my remaining DIEP flap patients to the ICU, despite the fact that these patients had never previously required ICU care. The ICU is one of the most expensive places in a hospital. So I called hospital leadership to explain why I believed this wasn’t in the best interest of patients. I’m sharing that conversation with you. Over the past 13 years, our team has performed thousands of breast reconstruction procedures with a 99.7 % success rate. These patients do not need ICU care. They need specialized nurses who understand breast reconstruction, early mobility, and a pathway that gets them safely home. The documented rationale for the change had nothing to do with patients actually needed more acute care. It had everything to do with declining case volume. We can learn a lot about priorities by observing how people and systems respond to stress. I improved outcomes and lowered the cost of breast reconstruction by moving it to an outpatient center. The system responded by increasing the cost per patient. We should all take note.

Elisabeth Potter MD

55,542 views • 11 days ago