Insurance Company Disrupts Surgery Mid Procedure

In a recent incident that has sparked widespread outrage, Dr. Elisabeth Potter, a plastic surgeon based in Austin, Texas, reported being interrupted mid-operation by a call from UnitedHealthcare. Dr. Potter was performing a bilateral DIEP flap surgery—a complex breast reconstruction procedure for a cancer patient—when she was informed that the insurance company required immediate information regarding the patient's diagnosis and the necessity of an overnight hospital stay.

Concerned about potential repercussions on her patient's coverage, Dr. Potter felt compelled to scrub out of surgery to return the call. During the conversation, the UnitedHealthcare representative appeared unaware that the patient was undergoing surgery for breast cancer and questioned the need for post-operative hospitalization, despite prior approval of the procedure. Dr. Potter expressed her frustration, stating, "It's out of control. Insurance is out of control. I have no other words."

This incident highlights ongoing concerns about the influence of insurance companies on medical decisions and patient care. Prior authorization processes, intended to manage healthcare costs, are increasingly criticized for causing delays and obstructing access to necessary treatments. A 2022 survey of oncologists revealed that 80% of cancer patients experienced disease progression due to treatment delays attributed to prior authorization requirements.

In a related development, shareholders of UnitedHealth Group, the parent company of UnitedHealthcare, have called for a comprehensive review of the company's practices that may limit or delay access to healthcare. Led by the Sisters of the Holy Names of Jesus and Mary of Quebec and Trillium Asset Management, the proposal requests a report analyzing the public health impact and economic risks associated with such practices. The shareholders expressed concerns that these policies could harm the company's reputation and have broader economic implications by increasing consumer debt and reducing workforce productivity

UnitedHealth Group has responded to these criticisms by stating that it approves and pays about 90% of medical claims upon submission. The company described the recent criticisms as "highly inaccurate and grossly misleading."

The convergence of these incidents underscores the urgent need for a reevaluation of insurance practices that affect patient care. As Dr. Potter emphasized, the current state of affairs is untenable, and without significant changes, the healthcare system risks further decline, to the detriment of patients and providers alike.

These incidents show just how urgently insurance practices need to change. Dr. Potter made it clear—things can't stay this way. Without real reforms, the healthcare system will continue to hurt the very patients it's meant to protect.