In January, Dr. Elisabeth Potter said she was midway through performing a breast reconstruction surgery when a call from a representative from UnitedHealthcare came into the operating room. The health insurance company wanted to talk about the patient on the table.
“I got a phone call into the operating room saying that UnitedHealthcare wanted to talk to me and that they wanted to talk to me now,” Potter, a plastic surgeon, told NBC News. Potter posted a video on TikTok recounting the call that’s reached nearly 6 million views.
During the call she said the UnitedHealthcare representative wanted more information on why the patient needed an overnight hospital stay, even though the surgery itself had already been approved.
“The person on the phone asked for her diagnosis, for the patient who was under anesthesia on the table,” she said. “That call was just this wake-up call. If they can ring me in the operating room, not for something urgent, just for that, and to ask me to justify her staying overnight … we have lost our way.”
Potter acknowledged that it was her decision to step out of the surgery to take the call. But “in 2025 with insurance,” she said, “when they say ‘jump,’ I say, ‘how high?’”
A spokesperson for UnitedHealthcare said the company “did not ask — nor would it ever expect — a physician to interrupt patient care to return a phone call about a notification error or any other insurance matter.”
Potter said UnitedHealthcare denied coverage for the hospital stay. The insurance spokesperson said the stay was approved but there was an error with a separate request.
Now, Potter said she believes UnitedHealthcare is retaliating against her because of her social media posts, putting her at risk of bankruptcy.
The health insurance company, she said, has not allowed her clinic — the RedBud Surgery Center in Austin, Texas — to join their in-network list of providers. She started the clinic in April 2024. Potter herself remains in network, meaning she can perform surgeries in a hospital, but because the facility is out of network, she can’t operate there.
(In network means a health insurer has a contract with a health care provider, agreeing to pay for services at preset rates. Out of network means there’s no contract, so the insurer could pay less or not at all. Patients are far less likely to see out-of-network doctors because, without insurance paying, the patients must cover the entire cost.)
Without being able to accept UnitedHealthcare patients in network, Potter said she likely won’t be able to stay in business. While she’s in talks to join other insurers’ networks, UnitedHealthcare is the second biggest player in the market, according to the Texas Department of Insurance.
Potter said she’s currently $5 million in debt and her husband had to cash out his 401(K) to help them stay afloat.
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“My goal has always been, how do I make this work? I’m a problem-solver,” she said. “The fact that they hold the strings in that way, that they’re able to control the economics of the practice of medicine down to the facility that I’m operating in, it seems just arbitrary and also somewhat cruel.”
The UnitedHealthcare spokesperson said the company informed Potter that its network was closed to new centers in October 2024, well before she began posting the social media videos. The spokesperson also said there was already a sufficient number of surgery centers in the area by Potter’s clinic.
The spokesperson added that Potter’s consultant continued to reach out to the company after October, but “there were no ongoing negotiations.”
Potter said that UnitedHealthcare remained in contact with her consultant until January, around the time she posted the viral video. “I don’t know how United defines negotiations, but there were ongoing communications pushing for me to be in network,” she said.
Ongoing tensions
Potter’s dispute, experts say, is one example of ongoing tension between insurers and health care providers.
Dr. Adam Gaffney, a critical care physician and assistant professor of medicine at Harvard Medical School, said that dealing with health insurance companies is “part and parcel” of the life of most doctors in the U.S.
Gaffney, who did not speak specifically about Potter’s case but the industry in general, said that part of health insurers’ jobs is to prevent unnecessary care as a way to counter the exorbitant cost of health care in the U.S., from pricey drugs to expensive hospital stays.
But for many doctors, that means constantly dealing with prior authorizations, claim denials and other barriers to care that patients need — sometimes even after the care has already been given, he said. That applies even when providers are in network: A study from the health policy research group KFF found that in 2021 insurers denied an average of 17% of claims, even when patients received care from in-network doctors.
“I think this is the wrong way to do it,” Gaffney said. “There’s no question that fighting with insurance companies is not why people signed up to be doctors.“
The difficulties patients and providers face with health insurance companies drew renewed attention last year after the fatal shooting of Brian Thompson, the CEO of UnitedHealthcare, in New York City.
UnitedHealth Group — the parent company of UnitedHealthcare — has been under intense scrutiny. Following the death of Thompson last year, the company disclosed in a regulatory filing in July that it’s facing a civil and criminal investigation from the Justice Department after reports of a probe related to its Medicare billing practices. The company is also being investigated for potential antitrust violations, The Wall Street Journal reported, citing people familiar with the matter. The company told WSJ in a statement that it stands “by the integrity of our Medicare Advantage program.”
In May, Andrew Witty, the CEO of UnitedHealth Group, suddenly stepped down, citing “personal reasons.”
A New York Times report published in July said the health insurer has sought to silence journalists, filmmakers and health care professionals who criticize them online. The Times’ report cites a number of sources by name, including Potter. In a statement, a spokesperson for the company told the Times, “The truth matters, and there’s a big difference between ‘criticism’ and irresponsibly omitting facts and context.”
“I think more and more people are coming to understand that insurance companies are doing a good deal of the rationing that is a part of the American health care system,” said Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center in New York City. “I think that the system that we have, private for-profit entities telling us what our medical care should be, is ridiculously immoral.”
“It’s going to take serious government intervention,” Caplan added. “If we don’t do it, we’re still going to wind up with all these disputes as insurers try to contain costs.”
Keeping the lights on
Potter agreed that the broader health care system needs fixing, adding that she feels “strongly” that health insurance is a good thing as it makes care more affordable for patients.
Potter said she left hospital work and opened her own clinic in April 2024 after realizing she could provide the same services at a lower cost to both patients and insurance companies — while earning more herself.
“I’m just trying to do surgeries that women need and like in the best way possible,” she said.
She said she took out $3.5 million in personal loans to open the clinic, even jumping through hoops to get it certified so they could legally accept private insurance and Medicaid patients, something that not all surgery centers are able to do.
“It’s such a scam,” she said. “You have to pass all the health hurdles when you build a surgery center to make sure it’s a safe place for patients. And then, as someone who wants to provide care, then you have to approach insurance companies.”
Because of insurance issues, she said she’s currently not taking a salary and may only have a few months left to stay in business.
“All I want is for the patients who are medically appropriate to be at RedBud Surgery Center to have their surgeries here, same care for patients, and it helps keep my doors open and the lights on, and it’s less expensive for the system.”
