Texas surgeon says UnitedHealthcare dispute may force her into bankruptcy

In January, Dr. Elisabeth Potter said she was halfway by performing breast reconstruction surgery when a call from a representative of Unitedhealthcare entered the operating room. The health insurance company wanted to talk about the patient on the table.

“I received a telephone call in the operating room saying that Unitedhealthcare wanted to speak to me and that they wanted to talk to me now,” Potter, a plastic surgeon, in NBC News. Potter published a video on Tiktok telling the call that reached nearly 6 million views.

During the call, she said that the representative of Unitedhealthcare wanted more information on the reasons why the patient needed one night stay, even if surgery itself had already been approved.

“The person on the phone asked for his diagnosis, for the patient who was under anesthesia on the table,” she said. “This call was only this awakening. If they can make me ring in the operating room, not for something urgently, just for that, and to ask me to justify it to spend the night … We have lost our way.”

Potter admitted that it was his decision to get out of the surgery to take the call. But “in 2025 with insurance”, she said, “when they say” jump “, I say:” What is the height? »»

A spokesperson from Unitedhealthcare said that the company “had not asked – and she never expected it – a doctor to interrupt patient care to return a telephone call concerning a notification error or any other insurance case.”

Potter said Unitedhealthcare had denied a coverage for the hospital. The insurance spokesman said that the stay had been approved, but that there had been an error with a separate request.

Now Potter said she believed that Unitedhealthcare retreated against her because of her publications on social networks, endangering her in bankruptcy.

The health insurance company, she said, did not allow its clinic – the Redbud Surgery Center in Austin, Texas – to join their list of network suppliers. It started the clinic in April 2024. Potter itself remains in a network, which means that it can do surgeries in a hospital, but because the establishment is out of network, it cannot operate there.

(In the network means that a health insurer has a contract with a health care provider, agreeing to pay services at predefined rates. Outside the network means that there is no contract, so the insurer could pay less or not at all.

Without being able to accept UNITEDHEALTHCARE patients in the network, Potter said she could probably not stay in business. While she is in talks to join other insurers networks, Unitedhealthcare is the second largest player in the market, according to the Texas Department of Insurance.

Potter said she was currently $ 5 million in debt and that her husband had to remove her 401 (K) to help them stay afloat.

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“My goal has always been, how can I run this?” I am a problem of problems, ”she said. “The fact that they hold the strings in this way, that they are able to control the economy of the practice of medicine to the installation in which I operate, it seems just arbitrary and also somewhat cruel.”

The spokesman of Unitedhealthcare said that the company had informed Potter that its network was closed to new centers in October 2024, long before it started to publish social media videos. The spokesperson also said that there was already a sufficient number of surgery centers in the region by the Potter clinic.

The spokesperson added that the Potter consultant continued to contact the company after October, but “there were no negotiations in progress”.

Potter said Unitedhealthcare had stayed in touch with his consultant until January, when she published the viral video. “I don’t know how United defines negotiations, but there have been continuous communications that push me to be on a network,” she said.

Current tensions

The Potter dispute, according to experts, is an example of continuous tension between insurers and health care providers.

Dr. Adam Gaffney, intensive care doctor and assistant medical professor at the Harvard Medical School, said that treating health insurance companies is “an integral part” of most doctors in the United States

Gaffney, who did not speak specifically about Potter’s case, but the industry in general, said that part of the job insurers are to prevent unnecessary care as a means of countering the exorbitant cost of health care in the United States, expensive drugs at expensive hospital stays.

But for many doctors, this constantly means dealing with previous authorizations, refusal of complaints and other obstacles to care that patients need-sometimes even after care has already been given, he said. This applies even when the service providers are in a network: a study of the KFF health policies research group revealed that in 2021, insurers denied an average of 17% of complaints, even when patients received care from doctors on the network.

“I think it’s the wrong way to do it,” said Gaffney. “There is no doubt that fighting with insurance companies is not the reason why people have registered to be doctors.”

The difficulties that patients and providers face with health insurance companies drew renewed attention last year after the Mortelle shooting by Brian Thompson, CEO of Unitedhealthcare, in New York.

Unitedhealth Group – The parent company of Unitedhealthcare – was registered intense. After the death of Thompson last year, the company revealed in a regulatory file in July that he was facing a civil and criminal investigation with the Ministry of Justice after having reported a investigation linked to his Medicare billing practices. The company is also the subject of an investigation for potential antitrust violations, reported the Wall Street Journal, citing people familiar with the issue. The company told WSJ in a statement that it was “by the integrity of our Medicare Advantage program”.

In May, Andrew Witty, CEO of Unitedhealth Group, suddenly resigned, citing “personal reasons”.

A New York Times report published in July said that the health insurer had sought to silence journalists, filmmakers and health professionals who criticize them online. Times’ report cites a number of sources by name, including Potter. In a statement, a company spokesman told Times: “The truth is important, and there is a big difference between” criticism “and irresponsible omission of facts and context”.

“I think that more and more people understand that insurance companies are a lot of rationing that is part of the American health care system,” said Arthur Caplan, head of the Nyu Langone Medical Center medical ethics in New York. “I think the system we have, private for -profit entities telling us what should be our medical care, is ridiculously immoral.”

“It will take a serious intervention from the government,” added Caplan. “If we don’t do it, we will always end up with all these disputes because insurers try to contain costs.”

Keep the lights on

Potter has agreed that the wider health care system should be repaired, adding that it feels “strongly” that health insurance is a good thing because it makes care more affordable for patients.

Potter said she left the hospital and opened her own clinic in April 2024 after realizing that she could provide the same services at a lower cost to patients and insurance companies – while earning more.

“I’m just trying to do surgeries that women need and like the best possible way,” she said.

She said that she had contracted $ 3.5 million in personal loans to open the clinic, even jumping through hoops to certify it so that they can legally accept private insurance and Medicaid patients, which all surgery centers cannot do.

“It’s such a scam,” she said. “You have to spend all obstacles of health when you build a surgery center to make sure that it is a safe place for patients. And then, as a person who wants to provide care, you must approach insurance companies.”

Due to insurance problems, she said that she was currently not paying wages and can only have a few months left to stay in business.

“All I want is that patients who are medically appropriate are at Redbud Surgery Center to undergo their surgeries here, the same care for patients, and this helps keep my doors open and light lights, and it’s cheaper for the system.”