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health insurance
'Out of Control': Insurance Giant UnitedHealth Calls in Middle of Cancer Surgery to Question Necessity
Dr. Elisabeth Potter shared "another horror story from a doctor dealing with United Healthcare's terrible authorization process."
Jan 09, 2025
A month after the killing of UnitedHealthcare CEO Brian Thompson prompted many Americans to share personal horror stories of the company's coverage denials and other practices, a doctor in Austin, Texas on Wednesday shared her own experience that she said exemplified how the for-profit health system "just keeps getting worse."
In a video posted to TikTok, Dr. Elisabeth Potter said she recently received an unprecedented phone call from UnitedHealthcare about a patient—one who was already under anesthesia and having surgery.
Potter, a plastic surgeon who specializes in reconstructive surgery for breast cancer patients who have had mastectomies, said she was performing a bilateral deep inferior epigastric perforator [DIEP} surgery when UnitedHealthcare called her in the operating room.
The call was urgent, she was told, and needed to be returned right away.
"So I scrubbed out of my case and I called UnitedHealthcare, and the gentleman said he needed some information about her," said Potter. "Wanted to know her diagnosis and whether her inpatient stay should be justified."
Potter found that the person calling wasn't aware that the patient whose care he was questioning had breast cancer and was in the operating room—that information was known by "a different department" at UnitedHealthcare.
Potter's account, said Nidhi Hegde, managing director at the American Economic Liberties Project, was "another horror story from a doctor dealing with United Healthcare's terrible authorization process."
"Ridiculous that doctors/nurses are spending time explaining their work to an insurance company instead of being able to focus on care," said Hegde.
As Common Dreams reported last month, cancer patients have become disproportionately affected by "prior authorizations" demanded by for-profit health insurers, which require doctors to get approval for treatments. Prior authorization can delay lifesaving care and one survey of oncologists in 2022 found that patients experienced "disease progression" 80% of the time an insurance company's bureaucratic requirements delayed their treatment.
Potter had to inform the UnitedHealthcare staffer that the company had already given her approval for the surgery.
She said she told him, "I need to go back and be with my patient now" and was able to continue the procedure.
"But it's out of control," she said. "Insurance is out of control. I have no other words."
Even before Thompson's killing, UnitedHealthcare has garnered outrage for the numerous methods it uses to deny healthcare coverage to patients.
A Senate investigation found the company intentionally denied claims submitted by nursing home patients who suffered strokes and falls, in order to increase profits. The company also faces a class-action lawsuit for using an AI algorithm with a 90% error rate to deny coverage to senior citizens with Medicare Advantage plans,
In December, ProPublica published an investigation that found the company is one of several insurers who repeatedly relied on the advice of company doctors who have wrongly recommended denying care.
In a follow-up video, Potter said on Wednesday that insurance companies have created "a fear-based system where, if an insurance company calls me and says I've got to call them right back, I'm afraid they're not going to pay for my patient's surgery, that patient is going to get stuck with a bill."
Potter toldNewsweek that the experience confirmed for her that "there is no room in healthcare where the pressure of insurance isn't felt by both patients and doctors. Not even the operating room."
UnitedHealthcare suggested in a comment to Newsweek that it did not call Potter during surgery, saying, "There are no insurance related circumstances that would require a physician to step out of surgery and it would create potential safety risks if they were to do so. We did not ask nor would ever expect a physician to interrupt patient care to answer a call and we will be following up with the provider and hospital to understand why these unorthodox actions were taken."
Potter joined many Americans in speaking out against the for-profit health insurance system in the days after Thompson's killing, offering a doctor's perspective.
"I want you to know that insurance companies are affecting the kind of care that you're getting, because they're applying pressures to physicians through their policymaking," said Potter in one video posted on TikTok. "This is a dark, dark time for healthcare, and we have to fix this or we're gonna go down a path that we can't get back from."
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Americans Are Angry About Their Health Insurance—With Good Reason
As a physician, I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.
Jan 01, 2025
How should we react when a man is shot to death on the street on his way to work? Our humanity tells us that we should be shocked and horrified—and feel that something is deeply wrong with such a brazen act of murder. Ideally, we would do what we could to help sooth the survivors, condemn the violence, and bring the perpetrator to justice.
So why did hundreds of thousands of people have the exact opposite reaction when UnitedHealthcare CEO Brian Thompson was executed in New York City last month? Because Americans are furious with health insurance corporations—and they have every right to be.
In the immediate aftermath of the shooting, many Americans took to social media not to mourn, but to celebrate. Caustic posts about prior authorization and denied medical claims were common. Sympathetic statements were met with rancor—and in the case of UnitedHealth Group’s own statement, over 70,000 “laugh reactions” before the company made that tally private. Even verbose political figures like Elon Musk and President-elect Donald Trump declined to comment for days. This shooting touched a raw nerve.
The health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.
As a physician who’s treated countless victims of gun violence, and who’s life’s work is to care for all of my patients, I found this response to be deeply unnerving. But I also can’t waive it away with simple explanations like online radicalization or trolling. Something much deeper is at play.
For decades, health insurance corporations like United have been growing more powerful and more profitable. How do they generate these profits? By taking in as much money as possible in premiums and paying out as little as possible in medical claims. Over time, they have tried everything from requiring “prior authorization” of care, to excluding high-quality providers from their networks, to imposing a Byzantine series of charges including ever-growing copays, coinsurance, and deductibles. When all else fails, many insurers simply deny claims.
Behind each of these practices are millions of Americans who are made to suffer. I hear these stories routinely in my practice, and they never become easier to stomach. I have seen patients with aggressive cancer who avoided seeing a doctor for months because they feared bankruptcy; patients with chronic conditions like diabetes who are denied treatments that would improve their quality of life; and gunshot victims whose fight to recover and gain a semblance of normalcy is complicated by their health plans saying no, no, and no again.
I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.
These are the stories that Americans are sharing in this fraught moment. We have to ask ourselves: Are we listening? And what are we going to do about it?
Insurers like UnitedHealthcare will have their own responses. Their PR teams will no doubt work overtime to marginalize aggrieved voices and to highlight what they consider to be the “value” of their health plans. Expect to see glossy commercials and towering billboards touting the “peace of mind” that Americans should enjoy knowing that their medical needs are “covered.” But the health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.
Behind the scenes, corporate insurers will no doubt lobby for the preferential treatment they have come to expect. Our newly elected Congress may acquiesce, or they may decide that the industry needs to be regulated—a strategy that has failed to live up to its promise.
Republicans and Democrats have made separate attempts to combine federal requirements with federal largesse in order to make corporate health insurers play nice. But both the Affordable Care Act and the Medicare Advantage program have only succeeded in ballooning the profits of firms like United—without improving Americans’ health or sparing their wallets.
It’s also clear that violence is not the answer, both on a purely human level and because corporate insurers will simply not be moved. UnitedHealthcare will have a new CEO in short order, and it will be that person’s responsibility to boost profits and make shareholders wealthier. Responding to patients’ cries will not serve these ends, so it is not in the cards.
What would help is a proven reform proposal that is long overdue: a single-payer national health program. Such a system would provide universal coverage and comprehensive benefits—with zero out-of-pocket costs. It could be easily implemented given the gargantuan sums we spend on healthcare in this country, and it would be a boon for those who are suffering, and for those who are fearful.
Americans are crying out in pain—and are recognizing that they are not alone in their pain. We should listen to these cries and we should finally, after decades of delay, do something about it.
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Nearly 7 in 10 Americans Say Insurers' Greed Played Role in UnitedHealthcare CEO Killing
"Believing the health insurance industry is at least partly responsible for the murder of the UnitedHealthcare CEO is not some fringe position," wrote one journalist.
Dec 28, 2024
In the wake of the killing of UnitedHealthcare CEO Brian Thompson in early December, some political observers were taken aback by the public response to the event, which included morbid humor and expressions of "Schadenfreude," in the words of one woman who had battled an insurance company to secure treatment for her mother's cancer.
But according to a new poll released by NORC at the University of Chicago Friday night, the belief that the for-profit health insurance industry's business practices were largely to blame for the apparent targeted killing of Thompson is far from a fringe viewpoint.
Sixty-nine percent of respondents placed a "great deal or moderate amount" of blame on healthcare coverage denials by insurance companies like UnitedHealthcare, for Thompson's killing.
Sixty-seven percent said exorbitant profits made by health insurers were to blame.
UnitedHealthcare, which reported $16 billion in profits last year, has garnered outrage for its claims denial practices. A Senate investigation earlier this year found the company was one of three that were intentionally denying claims made by nursing home patients who had Medicare Advantage plans and had suffered falls and strokes, in order to increase profits.
The company is also facing a class-action lawsuit over its use of algorithms to deny care.
Last year, a Commonwealth Fund survey found the 17% of Americans had been told by an insurance company that a medical claim was denied, and the poll suggested many patients and doctors feel powerless to stop companies like United from denying them care; more than half said they and their physicians did not challenge the insurers' decision.
That poll matched the results of the NORC survey released on Friday, in which 15% of respondents said they had had a claim denied.
The poll was released the same day that NBC Newspublished an investigation showing that cancer patients are disproportionately affected by claim denials and insurers' requirements that they obtain "prior authorization" in order to receive life-saving care, an arduous process that can delay treatment and allow their condition to worsen.
A study published in the Journal of the American Medical Association last year found that 22% of cancer patients did not receive treatment their doctors had prescribed because of denials or prior authorization requirements.
A survey of oncologists in 2022 found that 42% of prior authorizations were delayed by more than one business day, and 14% of the delays had a serious adverse impact on the patient.
The patients experienced "disease progression" 80% of the time and "loss of life" 36% of the time.
Insurers are increasingly relying on prior authorizations to delay or deny care for cancer patients, a 2023 study found. The number of nonspecialty oncology drugs that required prior authorization rose from 16% in 2010 to 78% in 2020.
NBC News told the story of one patient, Tracy Pike, who died after Blue Cross and Blue Shield of Illinois declined to cover a $40,000 treatment for Stage 4 stomach cancer—surgery and intensive chemotherapy—that had been recommended by his doctor.
Citing the findings of a company doctor—who was an obstetrician-gynecologist, not an oncologist—Blue Cross ruled the treatment was "experimental, investigational, and unproven," even though it is routinely prescribed for cancer patients.
Journalist Ken Klippenstein noted that the NORC poll included a nuance that was "sorely lacking in major media coverage" after Thompson's death, which at times suggested that people who acknowledged the insurance industry's deadly practices were "supporting" the fatal shooting.
The poll found that 78% of people believed the person who shot Thompson outside a hotel in Manhattan bore "a great deal" or a "moderate amount" of blame for the killing.
"Now compare that with the tsunami of corporate media op-eds and pundits expressing the sparkling insight that murder is wrong," wrote Klippenstein. "Yeah, we know. Episodes like these really show you how much contempt these elite media organs have for the public, which they apparently see as helpless children in need of a preschool level moral lesson."
"As the NORC poll shows, the vast majority of people know that, yes, of course murder is wrong—they just also happen to think there's more to the story than that," he continued. "And they're right: How can you have an honest discussion about any of this without addressing the Moloch-like industry that profits from denying people healthcare?"
But as Klippenstein wrote on Thursday, those who took part in that "honest discussion" in the days after Thompson's killing were branded as "extremists" not just by the media, but by law enforcement.
Days after the killing, Klippenstein wrote, the New York Police Department circulated an intelligence report on the suspected gunman, 26-year-old Luigi Mangione—but the report also included warnings about "ordinary people" who expressed sympathy for Mangione online.
"Warning of 'a wide range of extremists' that 'may view Mangione as a martyr,' the report's title singles out 'disdain for corporate greed," wrote Klippenstein, noting that the document was circulated to law enforcement and counterterrorism agencies nationally.
But as the latest polling shows, he wrote, "believing the health insurance industry is at least partly responsible for the murder of the UnitedHealthcare CEO is not some fringe position."
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