Dr. Insurance, MD, FACS

Writer: Youstina Swaha

Editor: Sathirtha Mondal

“Deny, Defend, Despose:” the words that shook up the world of healthcare, amidst the reeling reaction towards the killing of United Healthcare’s CEO. Health Insurance is often praised due to its benefits, often appearing more good than bad in general discussion. However, the ongoing discourse regarding the murder has uncovered the stark reality behind healthcare: patients being denied life-saving care and medication, and one trip to the hospital causing many to be in debt. There’s the idea that there’s “good” insurance, and there’s “better” insurance, but at what point do you start to consider how these restrictions affect patients and doctors?

Dr. Elisabeth Potter is a plastic surgeon who specializes in breast reconstruction, and she’s very familiar with the many hoops you have to jump through with insurance. Documenting her journey with insurance companies, one patient's experience stood out. Dr. Potter described, “being in surgery when she got a message that a health insurance representative was trying to reach her about a patient who, it turned out, was already on the operating table.”

This isn’t an isolated incident, as Dr. Potter documented a peer-to-peer call with what were supposedly doctors working for United Healthcare. The doctors on the other end of the line wouldn’t give out their name or NPI number due to what they cited as a “safety concern.” However, the more Dr. Potter discussed with them about their knowledge, the more apparent it became that these doctors weren’t well informed about the areas Dr. Potter operates in, with one doctor being an oculoplastic surgeon, and the other claiming to be a microsurgeon, the same specialty as Dr. Potter. “So you're not doing microsurgical breast reconstruction currently or treating patients with lymphoedema currently,” Dr. Potter asked in her peer-to-peer call. She then went on to ask a basic question to the doctor claiming to be a microsurgeon, “So, do you know what her risk of lymphoedema is? Well, I mean, … if you're my peer, then I think you should be able to answer that question because that's an important statistic, certainly for my patients who have lymphoedema.” As they failed to answer Potter’s questions, it became clearer that the approval would not go through, with Dr. Potter saying she’d appeal and continue to reach out to United Healthcare.

Bearing these two patient events in mind, the bigger picture of how vicious Insurance has become, denying care to patients that could be life-saving, and the one thing keeping them financially afloat. In a podcast called “The Checkup with Doctor Mike,” Dr. Potter was interviewed about her many trials with insurance companies. Speaking of this vicious cycle of denying, Drs. Mike and Potter mention that roadblocks are there for the sake of reducing fraud, but as Dr. Potter says, at what point is denial no longer just a safety measure but a killing machine? Dr. Potter speaks further about this, saying, “But when they're creating these roadblocks, they're creating them to decrease spending, not to eliminate abuse. Because if you see who's getting rejected, for every one abuse case, I mean, there's gotta be hundreds, if not thousands, of cases that are rejected simply as a cost-saving measure.”

With the medical world in shambles, scrambling to fill the never-ending need for more doctors, and medical school admissions becoming harder, a survey conducted in 2018 of 600 doctors found that 52% of doctors are thinking of leaving the profession due to the predatory nature of Insurance, with 89% believing “they no longer have adequate influence in the healthcare decisions for their patients.”

These problems aren’t just appearing now; the insurance industry’s vicious nature, which denies and delays care, can be traced back to discussions in 2012. In a video titled, “Deny, Disclaim, Delay - How Health Insurance Companies Really Work,” Dr. Rochelle G. Catus and her team discuss the many trials they’ve endured with insurance, with one instance having the doctor’s reimbursement still not coming through due to them not amputating the leg as planned, and instead spending the extra time and effort to save the child’s leg. Most frustratingly, as Dr. Catus points out, the influence of insurance companies shifted the focus of healthcare from practicing medicine and healing to dealing with business and finances.

Insurance companies’ treatment of patients as money symbols instead of humans with complicated histories can be extremely detrimental. One heartbreaking news story talks about a patient who, after being diagnosed with stage 4 stomach cancer, was denied coverage of a “routinely practiced treatment combining surgery and intensive chemotherapy” the night before his first surgery, citing it was not medically necessary, and “experimental, investigational and unproven.”

With more light being shed on the many atrocities of healthcare, it’s now more important than ever to speak up and speak out against these systematic injustices. While it might be difficult, making sure to advocate for a more patient-led focus in treatment is central to the betterment of healthcare. As more students enter the healthcare system, keeping these stories in mind to empower the fight for patient care can be the difference between life and death.

References:

1. Finnegan, Joanne. “Who’s Calling the Shots? Doctors Worry about Insurers Overriding Their Treatment Decisions.” Fierce Healthcare, 30 Oct. 2018, www.fiercehealthcare.com/practices/who-s-calling-shots-doctors-worry-insurers-overriding-their-treatment-decisions

2. Morgeonson, Gretchen. “'Would he have lived?' When insurance companies deny cancer care to patients.” NBC News, 19 Oct. 2024, www.nbcnews.com/news/investigations/-lived-health-insurance-companies-deny-cancer-care-patients-rcna182611

3. Potter, Elisabeth. “CNN Interview.” YouTube, uploaded by YouTube, 21 Sept. 2023, www.youtube.com/watch?v=_1rFcocqoA8

4. Potter, Elisabeth. “Deny.” YouTube, uploaded by YouTube, 13 Jul. 2025, www.youtube.com/watch?v=AZhCYisIQB8

5. Signature Medical Group. “Deny, Disclaim, Delay – How Health Insurance Companies Really Work.” YouTube, uploaded by YouTube, 15 Feb. 2024, www.youtube.com/watch?v=su-WzzUbBck

6. Varshavski, Mikhail. “Why Health Insurance Companies Hate This Plastic Surgeon …” YouTube, uploaded by YouTube, 10 May 2024, www.youtube.com/watch?v=R0vm8YlD1oo