In between scrubbing in for surgical procedures, Dr. Elisabeth Potter, a Texas-based plastic surgeon who works with breast most cancers sufferers, is preventing to drag again the curtain on the pitfalls of the medical insurance business.
Potter focuses on a process that includes utilizing fats and tissue from a affected person’s decrease stomach to rebuild breasts after a mastectomy or lumpectomy. Potter has carried out the surgical procedure, referred to as a deep inferior epigastric perforator (DIEP) flap process, greater than 1,000 instances, and mentioned she treats about 40% of ladies with breast most cancers in central Texas.
Courtesy of Dr. Elisabeth Potter
On social media, Potter shares movies that present the irritating actuality of navigating insurance coverage protection on behalf of her sufferers.
“We’ve behaved too predictably for a very long time, and the truth that it’s not regular for medical doctors and sufferers to get on social media and speak concerning the difficulties of well being care says so much,” she instructed HuffPost. “We have to begin talking out in order that there’s 100 medical doctors like me or 1,000 medical doctors like me saying sufficient is sufficient.” (For the complete story, watch the video above.)
In 2024, Potter opened RedBud Surgical procedure Heart in Austin in an effort to make breast reconstruction extra accessible and reasonably priced. She mentioned surgical procedures can usually price a affected person anyplace from $60,000 to $200,000 out of pocket.
“Many ladies who’re identified with breast most cancers and search breast reconstruction go to see a beauty plastic surgeon who would possibly solely take money or solely does an implant kind of reconstruction,” Potter mentioned.
Sufferers may additionally go to a microsurgeon like Potter, who makes use of a specialised microscope to carry out surgical procedure on among the physique’s most intricate constructions like blood vessels and nerves. “However many [microsurgeons] are solely out of community, that means the sufferers pays a penalty to go see them, or they really cost money,” Potter mentioned.
Potter mentioned proudly owning RedBud additionally helps her backside line. She will proceed her work whereas taking much less of a monetary hit as a result of RedBud collects the power charges related to a surgical procedure ― expenses for necessities like an working room, tools and medical employees.
“I got down to show a special case,” Potter mentioned. “I got down to construct a follow the place I do settle for insurance coverage, the place I don’t penalize the affected person for the system that we’re in, proper? So I settle for insurance coverage, and I do instances free of charge.”
Now Potter is elevating cash to “hold the lights on” at RedBud. She mentioned the issue is that UnitedHealthcare, Texas’ second-largest insurer, received’t presently settle for the follow — an ambulatory surgical procedure middle, or ASC — into its community. That makes it exhausting for her to run a worthwhile follow and for sufferers to afford pure tissue reconstructive surgical procedure.
UnitedHealthcare instructed HuffPost there may be already enough entry to ambulatory and cosmetic surgery facilities for its members in Travis County, Texas, even with out RedBud. UHC instructed Potter it wasn’t accepting any new ASCs again in October 2024.
However Potter claims she’s the one doctor within the county performing the DIEP flap surgical procedure exterior of a hospital setting, the place procedures are considerably dearer. She believes UnitedHealthcare’s actions are retaliation for her public criticism of them, although the corporate adamantly denies that.
Potter went viral in January when she revealed she left surgical procedure to take a name from UnitedHealthcare a couple of affected person as they have been on her working desk.
“It’s 2025, and insurance coverage simply retains getting worse,” she said in a video, nonetheless carrying a surgical cap. Potter described how UHC’s consultant requested her to justify the affected person’s in a single day keep, and she or he lamented that the medical insurance business was “uncontrolled.”
UnitedHealthcare demanded the movies be taken down and threatened authorized motion for defamation. In a press release to HuffPost, the corporate mentioned: “UnitedHealthcare didn’t ask — nor would it not ever count on — a doctor to interrupt affected person care to return a telephone name a couple of notification error or some other insurance coverage matter.”
UHC mentioned the decision was not pressing and solely occurred as a result of the hospital made an “faulty order of a separate inpatient keep.” However Potter mentioned she took the decision, and left the affected person within the care of a co-surgeon, as a result of she was decided to advocate for her affected person.
“I’ve sufferers on a regular basis who get payments which might be enormous and must dwell by means of the forwards and backwards with insurance coverage corporations or hospitals within the midst of the monetary devastation of a most cancers prognosis,” she mentioned. “So it was not a protracted leap to assume they might attempt to not pay for this, and so they might put this lady by means of much more hurt, this lady on the desk having mastectomies immediately, that they might put her by means of much more. And if I can take this name, in the event that they’re asking, let me take a name, and I can do this proper now, and let’s see if we will kind it out.”
UnitedHealthcare instructed HuffPost there have been by no means any negotiations about RedBud becoming a member of its community, however Potter mentioned ongoing communication with UHC went “radio silent” after she posted the video.
On the time of this story’s publication, UnitedHealthcare has not taken any authorized motion towards Potter. She continues to share her experiences, together with “peer-to-peer” calls with UnitedHealthcare representatives. Potter mentioned the calls are a part of the attraction course of if a service has been denied by an insurer, and a approach for suppliers and insurers to “get on the identical web page.”
“However that’s not what it’s like,” she mentioned. “It’s like they’re checking a field.”
Potter mentioned she hopes her posts may also help problem insurance coverage corporations and maintain them accountable.
“I believe there’s a extremely wholesome factor occurring now as a part of this dialog, which is that sufferers and suppliers are on the identical aspect…We should be trustworthy concerning the hurt that’s being completed by the financialization of drugs, and share that with our sufferers, in order that we will all struggle and push collectively,” she mentioned.
For the reason that dispute with UnitedHealthcare started, Potter says RedBud has been accepted in-network by different insurers, together with Aetna and Humana. She’s additionally heard from sufferers and physicians alike who’re cheering her on.
“On daily basis, a number of instances a day, one other physician reaches out and says, ‘Thanks,’” she mentioned. “One other retired physician who left drugs as a result of it was killing them morally reaches out and says, ‘Please hold preventing.’ One other affected person who’s encountering difficulties getting the care that they want reaches out and says, ‘You already know, I haven’t seen somebody struggle like this or inform the reality earlier than.’”
