Dr. Elisabeth Potter, a Texas plastic surgeon, is sounding the alarm about how disputes with health insurance companies can directly threaten patient care and the survival of medical practices.
In a striking incident earlier this year, Potter received a call from UnitedHealthcare while performing a breast reconstruction surgery — a call that interrupted care to question why the patient needed an overnight hospital stay, despite prior approval of the surgery itself.
“The representative wanted the patient’s diagnosis while she was still under anesthesia,” Potter recounted. “It was a wake-up call that insurance companies now have the power to disrupt care in real time, even when it’s not urgent.”
Potter’s experience reflects a growing problem in U.S. healthcare: insurance companies’ scrutiny and denial of coverage can place enormous pressure on both patients and providers. In her case, UnitedHealthcare denied coverage for the hospital stay, a decision Potter believes is retaliation for her viral social media posts criticizing insurer practices.
The denial has left her surgical clinic, RedBud Surgery Center in Austin, unable to join UnitedHealthcare’s network, restricting her ability to serve many patients.
This dispute threatens Potter’s clinic financially, as UnitedHealthcare is one of the largest insurers in Texas. Without network access, patients insured by UnitedHealthcare must pay out-of-pocket or forego care at her facility, endangering the clinic’s viability. Potter, now $5 million in debt and relying on personal funds, warns that insurance control over where and how care is delivered can be arbitrary and harmful.
Health experts say Potter’s story is far from isolated. Physicians nationwide often face burdensome insurance procedures — including prior authorizations and claim denials — that delay or block necessary care. Dr. Adam Gaffney of Harvard Medical School explains these insurer practices are part of cost containment but come at the expense of patient access and provider time.
Ethicists and advocates call the current system “immoral,” noting private insurers wield outsized influence over medical decisions that should be guided by doctors and patients, not profits. As Arthur Caplan of NYU Langone Medical Center says, meaningful government intervention is needed to ensure insurance companies do not ration care arbitrarily.
Potter remains committed to providing affordable, quality surgeries, having opened her own center to reduce costs for patients and insurers alike. Yet without network approval from major insurers like UnitedHealthcare, the future of her clinic and the care it provides remains uncertain.
Her story underscores the urgent need to rethink how insurance policies impact patient care and provider sustainability — so health, not paperwork, remains the priority.
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