Physicians are publicly calling out red tape and immoral practices. Vivian Manning-Schaffel gets the story.

Dr. Elisabeth Potter was still wearing a scrub cap when she fired off a now-viral Instagram post that took direct aim at the biggest health insurance company in the country. In her post, she talked about having to scrub out of surgery to hop on an urgent authorization call with United Healthcare, which was asking for details about her patient’s diagnosis and whether her overnight hospital stay was justified.

“Do you understand that she’s asleep right now? And that she has breast cancer?” Potter, a Texas-based board-certified plastic surgeon and breast cancer reconstruction specialist, says she told the rep on the phone. “Actually, I don’t. That’s a different department,” she says the rep replied. “When I get a call from an insurance company for a woman with breast cancer, I always think they’re going to try to deny her surgery,” she told The Meteor. After her post went viral, she shared another post on Instagram, a strongly worded letter from the attorneys of United Healthcare demanding that she take her post down, issue a public apology, and inform Newsweek that her “claims were false.”  

Then, she went on CNN.

It’s rare to see a doctor putting an insurance company on blast—partly because threats of legal action can be daunting for already overworked providers. Potter has long been the exception, taking to the morning-show circuit five years ago to advocate for safer breast implants despite what she called “bullying and pressure” from insurance companies. But since Potter’s post went viral, the floodgates have opened. Doctors like Washington, D.C. critical care physician Dr. Anita Patel, who recently took on Anthem Blue Cross Blue Shield for attempting to impose time limits on anesthesia, and Florida breast cancer surgeon Dr. Alicia Billington, who took Cigna to task for what she saw as failing to adequately cover reconstructive surgeries, have gotten more vocal about healthcare industry practices that they say sacrifice the well-being of their patients.

 

THE NIGHTMARE OF “PEER-TO-PEER” CALLS 

Dr. Shikha Jain, a hematologist and oncologist at the University of Illinois Cancer Center, has often used social media to amplify unjust insurance practices, tweeting about how insurance companies have delayed her patients’ urgent scans, denied coverage of a cancer combo therapy, and kept her on hour-long peer-to-peer calls. These delays and denials—which Dr. Jain calls “insurance scams”—are “all because insurance companies are just trying to save a buck and don’t care about the patients’ lives,” she said. Her online advocacy has led to op-eds, TV interviews, and an appearance in a New York Times Opinion video piece.

“When I get a call from an insurance company for a woman with breast cancer, I always think they’re going to try to deny her surgery”—Dr. Elisabeth Potter

One of Dr. Jain’s pet peeves? Those so-called “peer-to-peer” calls, like the one Dr. Potter had to make during surgery, when an insurance company doctor will speak with a patient’s doctor to verify the need for coverage. She’s missed peer-to-peer calls during busy clinic hours, when she sees patients back-to-back, and because she’s missed them, the insurance company denied the claim, she says. This requires the patient to appeal the decision, which can take several months.

What’s worse, the doctors interviewed say, the calls that can make or break a patient’s coverage aren’t always with doctors who share their specialty or expertise, sometimes resulting in significant care delays and perilous health risks for their patients. “You are the person, sitting in the room with the patient…crying with them because their chemotherapy has been denied,” Dr. Jain says, while “somebody who has never seen a patient with this disease is sitting at a computer a thousand miles away, making decisions based on an algorithm that is set up to deny care.” 

Dr. Anita K. Patel, a pediatric critical care physician at a large children’s hospital in Washington, D.C. says she recently called out Anthem BCBS “100% in response” to Dr. Potter’s own post about the company’s announcement that it would put time limits on anesthesia (a decision it has since reversed due to widespread backlash). “I work in an ICU for kids,” says Patel. “We would get notifications they were denying coverage.” She often finds herself on peer-to-peer calls fighting for life-or-death necessities like ventilators and wheelchairs. She once spent what she describes as a “demoralizing” hour in circles with an attending physician on the insurance side who was intent on denying an ICU stay to a vulnerable child with a life-threatening neurologic injury. “Any delay of care could cost the kid their life, and there was no way the parents could afford the bill,” she said.

“NOBODY WANTS TO BE IN THE HOT SEAT” 

So what can patients do when they’re at wits’ and wallets’ end with the insurance system? Besides keeping meticulous records of each contact with an insurance company and urging one’s workplace to pick plans that prioritize women’s health, Dr. Potter hopes patients will use social media for accountability, too. “I want to see open conversations about the nitty-gritty details of healthcare and the dark stories in courtrooms being had by providers and patients,” she says. But Dr. Jain says that while patients calling out insurance companies on social media can be effective, she understands why it could be the last thing they want to do. “How horrible is it if you’re being treated for cancer,” she says, “then on top of that having to go to social media and fight for your ability just to get treated? That’s not right.” 

It may not be right, but the discomfort of publicly pressuring insurance companies could lead to more meaningful reform. Though, it may be a long road. While editing this piece, Dr. Potter fired off another IG post saying another patient came to her with a denial from United. “Nobody wants to be in the hot seat,” Dr. Potter says, “but I want to make it more comfortable for doctors and patients to say insurance and hospitals are doing things that are not good for patients, and not good for providers.” 

 

Vivian Manning-Schaffel is a journalist and essayist who covers entertainment, culture, psychology, and women’s health. Her Substack, MUTHR, FCKD, covers pop culture through a feminist Gen X lens.