In Austin, Texas, Dr. Elisabeth Potter is known for her work in the operating room, performing complex reconstructive surgeries for breast cancer survivors. But earlier this year, the board-certified plastic surgeon found herself in a different kind of fight—this time, with the largest health insurer in the country.

In a now-viral video posted to TikTok and Instagram, Potter recounts being stunned when a UnitedHealthcare representative interrupted a patient’s surgery to question whether their overnight hospital stay was “justified.” After being told the call was urgent, Potter says she scrubbed out mid-procedure to speak with the company.

“I was like, ‘Do you understand that she’s asleep right now and she has breast cancer?’” Potter says in the clip. “And the gentleman said, ‘I don’t, actually. That’s a different department that would know that information.’” 

After the video went live, Potter says she was contacted by the insurance giant, accused of libel, and hit with thinly-veiled legal threats. But rather than back down, she has continued to document what she calls the most impossible part of being a doctor: not battling disease, but the insurance industry.

Dr. Potter joined Current Affairs Associate Editor Emily Topping and Editor-in-Chief Nathan Robinson to discuss the ways in which our broken healthcare system fails both patients and providers. This transcript has been lightly edited for brevity. 

Nathan J. Robinson

While your patients know you for life-changing surgeries, the world now knows you for a series of excellent and very insightful TikTok videos. I want to first ask if you could tell us a bit about your work, the kind of patients you see, and the kind of work you are doing.

Dr. Elisabeth Potter 

Certainly, I love my work. I'm a reconstructive plastic surgeon. I take care of patients affected by breast cancer, and my passion has really been to do that through insurance in communities. I take all insurance. Anything—Medicare, Medicaid, TRICARE. 

It's really been my passion to provide that care in communities, as opposed to in academic centers or in big cities, where the really complex reconstructions that we do have traditionally been available. I've spent my last 12 years doing really complex microsurgery in Texas and being a safety net for women from around the country, especially the South.

I take care of about 40 percent of the women in Central Texas who are affected by breast cancer. And then nationally, when you look at insurance companies, for instance, like United, I take care of greater than 3 percent of their complex breast reconstruction nationally. Just personally, I do. So it's really high volume in-network care that I've been doing for a long time.

Emily Topping

Wow. That's impressive, just for one, that you accept all of these types of insurance. I think that's pretty rare for a lot of doctors. But I know that you started one of your most viewed videos by saying simply, "insurance is out of control," and I'd love to know what you meant by that.

Potter  

So, although it's been my passion to accept insurance and to be in-network—I set out to do that—it's been so painful over the last decade to do it. And what I've seen over the last several years is just this creep of insurance into every aspect of healthcare, whether it's payment or reimbursement, whatever it is.

So the day I posted that an insurance company actually reached me in the operating room, and it was just so very absurd—it was as though I was supposed to be available to them in that location. So that's what I meant. It was just crazy.

Robinson 

A lot of the videos that you've posted, when you've discussed insurance, —and you discuss many things, but when you've discussed insurance companies and your interactions with them—they've been about the frustrating ways in which the company comes between you and the care that you want and need to give your patients. Could you elaborate on the ways in which that interference occurs in your day-to-day practice?

Potter  

I think it boils down to the fact that you've got these two forces at play. You have doctors who want to do the best thing for their patients health-wise, and you have companies that have a fiduciary responsibility to their shareholders to maximize profits. We're meeting in healthcare, and patients are feeling the force of that impact.

It's things like getting a preauthorization for a surgery. I employ two people full-time just to get authorizations for me to do necessary medical procedures for women affected by breast cancer. So I'm in-network, and I'm not trying to do anything out of network, cash pay. It takes two people all day long, full time, just to navigate that process. And then insurance companies tell you which drugs you can prescribe. They tell me what type of implants I can place, and it varies from insurance to insurance. So Blue Cross might be okay with me using, for instance, one product, and then another company says, no, you can't use that; you have to use a different product. So it requires me to make decisions based on the policy the patient has and not on my medical experience and recommendation.

Topping 

Potter 

Yes, I think I was shocked that I was reached in the operating room, but it is absolutely the case that doctors are interrupted in the middle of patient care every day to deal with insurance issues. And I'll give you a specific example. So when I, for instance, want to do a breast reconstruction, I might call UnitedHealthcare and say I want to do the surgery. And they say no. And I say, "Well, what's my recourse?"

They say, "You could have a peer-to-peer conversation about this."

I say, "Okay, I'd like to do that. Let's schedule it."

And then they tell me our only time slot available is at 3pm today, when I'm in the operating room or in clinic. And then they say, "If you don't do the call by 4pm, we're going to deny it."

So it's like, drop everything, show up, jump when we say jump, and go as high as we ask you to go, and then, usually, I get on and they say, "well, we're going to deny it," and then I have to appeal. So I think the principle that doctors are interrupted constantly to deal with insurance issues is a really important one, and being called out of the operating room was crazy, but it was just taking it one step further. And doctors from around the country reached out to me and said they can't believe that. In the letter that United sent to me, they said, "Oh, we would never do that." And doctors around the country called BS on that. They were like, no way, they do it all the time. They do it all the time.

Robinson 

Another thing you mentioned in one of your videos is not only do they say you have a call at this time and we'll call you, but sometimes they don't even call you at that time. And then you have to waste your time waiting to speak to them.

Potter 

And this is why I started to share these absurd moments, because they're living in my head rent-free. So I have this impression of insurance companies that's been developed over time—but the public isn't privy to that, and they don't know that all of us doctors have all of these experiences. We're used to, as physicians, putting our needs to the side and just dealing with the patient issue in front of us, but it felt like it was time to start talking about the background noise and letting you guys in to hear what's really going on.

So when I have a phone call, a peer-to-peer call that's scheduled, and then they're an hour-and-a half late, and I can tell that the person is distracted. It sounds like they're at a grocery store, like getting their groceries. And then I say, "Well, I'd like to talk to you about diep flap surgery." And I hear a pause, and then I say, "Do you know what a diep flap is?" And they say no. I'm like, why am I even on this call? I feel bad for all of us here. This shouldn't be this way.

Topping  

That was what really stood out to me from one of the more recent videos that you posted. I think it was a diep flap surgery that you were trying to get coverage for from one of your patients—and number one, the doctor who was on the other end of the line wouldn't identify themselves.

And even when you pushed for it, it sounded like they were an ophthalmologist, which is an eye doctor. So obviously a completely different field that wouldn't even necessarily know what you're referencing in this case. Can you tell us a little more about that? 

Potter 

Yes, so that case was actually a microsurgery case, but it was for something called a lymphovenous bypass, and it treats lymphedema, which is debilitating for many women who are affected by breast cancer. And we, for many years, have not had a treatment for that, but we do now. We have something we can offer. So in that case, I called to have this peer-to-peer—they called me—and that's a funny call. They showed up with two doctors on the call. And I was like, Ah, they know it's me—they know it's Dr. Potter. Because that's not normal, you don't usually get two doctors on the call. And then they were trying to meet the letter of the law. So they had a doctor in Texas—I think what you're supposed to have is a doctor in the state who's in the same specialty. So they were kind of patching it together. They had a doctor in Texas who's an ophthalmologist who said that they had a plastic subspecialty, and as soon as they said that I had their number because no plastic surgeon would say, I'm a plastic subspecialty. That's just not something we say. So it's funny how someone's vocabulary reveals their expertise. And then the other surgeon was just a cosmetic surgeon. And I think in that phone call, I tried to keep my cool, and I usually do try, but I was trying to find out what level of expertise they had without them providing their license number or credentials. So I had to dig deeper, and I had to ask questions like, do you know the percentage of patients who develop lymphedema in this circumstance? Because they wouldn't give me their credentials. I had no other other thing to go on. I needed to verify in a very specific way. I wasn't trying to embarrass anybody. I was just trying to get to the heart of the matter.

Topping 

What is a peer-to-peer call? If you could sort of summarize that just a little bit. Are these doctors who are paid as consultants specifically by the insurance company in order to, I assume, cover fewer procedures?

Potter  

Okay, I have never worked for an insurance company in that capacity or seen a contract for that, so I can't tell you exactly how it's structured, but in theory, these are my peers. So this should be a call between peers to discuss a medical matter and to come to a medical decision. It's an opportunity for me to be heard on behalf of my patient, but in practical language, what happens is it's just a box they're checking. In fact, in the call that you referenced, at the end of the call, the doctor said to me, I don't have the power to make this decision anyway—United has already decided. And I was like, there we have it. What a waste of our time. And it's like, it's for show. So, yes, a peer-to-peer call is supposed to be a chance for me to advocate for patients. And I will tell you that with some insurance companies, it is a bit more like that. So sometimes they get on a phone call, and it feels like, okay, we have something in common, me and the peer, and that is the patient, and we're going to try to come to a decision about something for a patient who helps that patient. And the ones that I've posted, obviously it's not that.

Robinson 

Just to sort of help us better understand how this system all works, the very fact that you're advocating for patients—you're a doctor, you're supposed to treat patients and then tell the insurance company what the patient needed, and then the insurance company has to pay if the thing is covered by the policy. But instead you're having to sort of be a lawyer as well as a doctor, in which you're having to convince this company, and then the company, as far as I could understand, is like the ultimate decider of what treatment is medically necessary, even though they've never met or examined the patient, and they're maybe in another state.

Potter

Yeah, it sounds like you're describing a company making medical decisions. 

Robinson

Yes.

Potter

That's what it sounds like. And it shouldn't be that way. But I think even just breaking it down that simply for the public, because I, as a doctor, think it's reasonable for a patient to think that they come to see you, get an exam, get a diagnosis, and they'll get a recommendation for treatment, and hopefully you helped in obtaining that treatment. And what actually happens is I can do an exam, and I can come to a diagnosis, and I can even recommend treatment, and then the work starts. Then the work starts. Then it's like, how do I get this for you? And I spend a lot of my time just trying to get the ball across the goal line. So it's not what I signed up for when I wanted to be a doctor, and I think it's what's burning out a lot of physicians.

I think most of the frustrations that I see patients experiencing as well, whether it's with a prescription or a surgery getting scheduled or canceled, aren't usually, for the majority of them, in those initial interactions. They're not in the exam and the diagnosis and the discussion, they're in just executing it. And isn't that what insurance is there for? Isn't that really the only piece they're there for? Why aren't they doing that well? Because I'm I'm showing up and doing a great job at all the other parts.

Topping 

Yes. And in a perfect world, obviously, you would be able to enter your clinic and do what you've trained for years and years to do: which is help patients, diagnose issues, and help them move on with their lives.

It's absurd that this is even a part of it, but when you're coming up with kind of a diagnostic treatment plan for patients, is this something that you have to discuss with them? Or something that they bring up? Whether it's choosing the best option for their health or what's the cheapest option, what is my insurance going to be able to cover?

Potter  

Unfortunately, in every consult, in every interaction, I discuss the Women's Health and Cancer Rights Act. I tell patients, this is covered by insurance under the Women's Health and Cancer Rights Act, and we'll submit our orders—let's talk about the challenges. And they'll say, have you ever seen this be denied? And I'll say, in a lot of instances, yes, I have, but I will go to bat for you, and we will do the peer-to-peer calls and the appeals, and if we have to go to Washington, DC, or call a congressperson, we will do that. And I've done all of those things. But every patient affected by breast cancer has to battle this. And it's not just breast cancer either. Everybody interacting with the medical system in the US has to. It's like you have to put a filter on what your doctor says. So you get all this great information, and then you apply the filter, and the filter is, what does United let me have? How many pieces of that recommendation do I actually have access to? And then it's not just access. It's also that reimbursement drives access. And so, it just goes on and on. I could go for days.

Robinson 

What a cruel human tragedy to know that things can be done, to have the skill, to have the equipment, and to have the time, but to be unable to do them because of this corporate entity that controls the money. And as you said, you're dealing with women with breast cancer. You're dealing with women who are going through the worst thing that has ever happened to them, who are facing the possibility of death, and then having to spend all this time just fighting to get the thing that you know could be [denied]—isn't it bad enough having breast cancer in the first place?

Potter  

I'll tell you two things that come to mind. One is I had a patient recently who told me, and you may have seen this, that that she was more scared of the insurance company than she was of her cancer diagnosis, and that was after months of battling with an insurance company to get a mammogram, a biopsy, and a surgery, and then finding out she had metastatic cancer. And she said that, from a cancer treatment standpoint, she believed her doctors knew what was best, and she could understand the rationale of treatment, but that insurance was just so cruel and unpredictable, and that was frightening to her.

The other thing I would say is that, in the US, I would assume that—sure, I encounter problems all the time in the healthcare system, but I'm a problem solver, and I can come up with ways to navigate that and spend a lot of time doing that. I think that's what some of my videos are about. What I'm seeing increasingly is that insurance companies are seeing doctors try to navigate, and so they're throwing up more obstacles. No, you can't do that. We're going to keep you out of network. No, you can't start a surgery center. No, we're in charge of everything.

It's almost like the mob. It's like, I want to put up a shop on a street—I'm a surgeon, that's my skill, or I'm a baker, that's my skill—but to have a shop on this street, you have to pay a tax to the Godfather. That's what it feels like to practice medicine in 2025. I have to pay a tax to the Godfather, and that's insurance.

Topping 

It's insane. And you mentioned something called the waiver system, or waivers, can you explain that little bit.

Potter

Oh, man. 

Topping

From what I gathered, it's basically that if insurance companies can prove that there isn't a clinic or a doctor that can provide a certain treatment within an area that they cover, they can say, "Hey, not our fault, none of these doctors will work with us."

But it sounds like it's a little more complicated than that, and they might be kind of hiding some of the negotiations that go on. Could you tell us about that?

Potter

Absolutely. I think, just for your listeners, an insurance company is not allowed to sell a product that doesn't have an adequate network of doctors and facilities. So you shouldn't be able to sell a product to an American in the US that doesn't have doctors who can treat common medical conditions, and facilities that they can go to, to use that insurance. So that makes sense. Well, in practicality, these days, there are many products out there being sold—a lot of insurance policies that have networks—that are inadequate. So I will meet patients who can't find a doctor who takes care of breast cancer in-network, or can't find a mammogram facility in-network, and you wonder, how does that happen? So the way that happens in Texas is that an insurance company—so they want to sell their product. They go to the state of Texas, and they say, we've tried our best—we've tried our best to have all the doctors in-network to meet all the network standards that Texas requires of them, but we haven't been able to do that. And so we're asking you, Texas, for a waiver so that we can continue to sell our product even though we're trying our best. I will tell you personally that in my own zip code, United has applied for waivers for surgery centers, the kinds of surgery centers that I want to have in-network that I own, and they won't let me in network. It's crazy. 

Robinson  

You had this video where the thing they did was they came along with offering to pay some ridiculously low reimbursement rate. And then when you're like, okay, let's negotiate, they were like, I guess there's no one who could provide it.

Topping

Like they checked the box and said, "Hey, we tried to negotiate!"

Potter 

That was a different insurance company, and I'll tell you how I learned about that. I learned about that when the Texas Department of Insurance sent me a letter saying, hey, is this true? Insurance company X said that you weren't willing to negotiate. And here I am thinking, we're in negotiations. They haven't even told me they've broken it off. They just made an attempt to document an attempt, and then went to the state of Texas to say we'd like a waiver—she wasn't willing to take 60 percent of Medicaid or Medicare. I found out from the state of Texas, and then I called up the Texas Department of Insurance and was like, someone's committing a crime—this is fraud. And they were like, this is the reference number for the call. I'm like, I just can't.

Topping 

Do you spend a lot of time in those kinds of loops where they're like, "You're actually speaking to the wrong person for this question"? It's like they're trying to exhaust you and wear you down?

Potter  

I think it's baked into the business model. And we know that based on even simple things like denials. So less than one percent of denials in insurance are appealed.

Topping

Really?

Potter

Yes, yes. So why would an insurance company issue a lot of denials? Well, if you think about the money side, they don't want to pay. So one way of doing it is to deny a lot and know that few people will appeal. That's really dark, but that's the kind of thing that's happening. It’s like just throwing gum in the works so that people don't actually use the expensive parts of of care.

Topping  

And is that just because they assume people won't appeal? They do it because people don't have the resources or the time to dedicate to this?

Potter 

Again, I'm just talking about the studies that show that less than 1 percent of denials are appealed, and then I see the ways that companies behave. I can only assume that that is baked into their business model. I'm not privy to those conversations. But something is amiss.

Robinson 

Now, after you posted your video about how UnitedHealthcare called you when you were in surgery, the company apologized profusely to you and rolled out a new set of practices showing that it would never happen—oh, I'm sorry. They said you had defamed them, and they threatened legal consequences, and you were recently featured in The New York Times in an article about how they do this to all of their critics. Could you please elaborate?

Potter

I love this. This is so great. It's funny how time and space give me the ability to laugh at this. Because the day that I received that call, I sat in my car at five in the morning going in to perform breast reconstruction. I was terrified. I was terrified because I knew that a company as big as United could take me down. And I also knew that I'm going to have to decide, do I speak up? What do I do? Am I just going to try to make this go away or apologize like they wanted me to? But in my gut it's just not who I am. I've never been somebody who backed down when someone else was getting bullied, and I know what's right, and I've got to be able to sleep at night.

I'm 49 years old, and I know what it's like to do something and regret that you did it. I'm not doing that here. I'm going to take the beating, and I'm going to stand up. I'm just going to trust the universe that something good will happen. And it's been painful, but it's been the right thing. The fact that we're having this conversation means that was a good decision.

Topping 

Yes, and I feel like you've been able to stir up a lot of conversation from people. I think there are many people who have had horrific personal experiences with our insurance companies but may not know that this is kind of built into our standard of care for what people have to deal with. When it comes to United, you even mentioned that someone showed up at your house to try and talk to you?

Potter 

Okay, so that was actually not United that showed up. That was the president of a society. So that's a different thing. It wasn't United that showed up my house. Now, I've not said this out loud before, but right after I received that letter, for about two days when I walked out of my house, there was a car parked there—very early in the morning, a dark car. I had a feeling that somebody was there just observing me. I'm not paranoid, but I did have that feeling.

I also went to the hospital shortly thereafter, and they had installed cameras in my operating room—only in mine. The hospital installed cameras in the operating room. And I was like, why did you guys do this? There you have 20-something ORs. Why in my ORs? They said it was something they were doing. But that was around the time when the hospital, which is a big group, and United, were talking about how this phone call had happened. But the person showing up at my house was from an academic society or a professional society, and they were telling me that I needed to be quiet about advocating for coding changes.

Robinson 

People should read the New York Times article that just came out, which is about the extraordinary lengths that they have gone to. People who hear what you're saying there, without context, might go, but that sounds crazy, but actually, you're not the only one who they've done this to. And also, they talk about how you were hoping to get to be classified as an in-network provider with UnitedHealth, and after your video went viral, they stopped replying to you because you exposed this really heinous practice.

You're just telling the truth about how this system works. But they have all sorts of ways in which they—the letter they sent just threatened you, suggesting you defamed them and suggesting that you needed to apologize. You used the language of the godfather earlier. Really, short of outright violence, they are using every means of coercion that can possibly be used within the bounds of the law.

Potter  

Yes, and that's what it feels like. It feels like if I behave nicely, if I'm a nice girl, then they'll leave me alone. But if I have things to say, and if I have opinions about the way that they're directing care, then I bear the brunt. And it's in subtle ways, but and it's also obviously in more direct ways, like receiving that letter. It's a dark time.

It's a dark time, but it's also encouraging to see that both patients and providers are on the same side here, and I didn't feel that before. Before, I often felt like patients blamed doctors and doctors blamed patients. That really did work well for insurance companies because we weren't noticing them. But now we're like, wait a minute, why are we fighting each other? There's somebody else pulling the strings here.

Topping 

Do you think that was a misconception that people had—that their doctor was personally responsible for how much they had to pay?

Potter 

Totally. Patients would say, why can't you do that? And I would say, it's not covered under your insurance—you can pay cash for that. And they would be like, you're asking me to pay cash—no, ma'am, I would never, ever do that. I'm telling you that this is the situation we're in. So just having these conversations now where people start to understand that a lot of the difficulties are in the system and in the bureaucracy and not because doctors don't want to do the right thing.

Robinson

One of the remarkable things about this being UnitedHealthcare is obviously there was the prominent incident with the assassination of the United CEO. I think, obviously, very few people think that assassination is an effective way of reforming the insurance system. But what was remarkable about that incident was that afterward, many people came out and said, I don't support the act, but I feel a lot of anger towards towards this company. And it's remarkable that the company, instead of responding to that by saying, okay, well, we really want people to not be pleased by an incident like this—something's gone terribly wrong if this is the public reaction—seems to have continued some of its worst practices and not reformed.

But I just wanted to conclude here by talking about the model of what healthcare should look like, to be forward-looking, because one of the things you talk a lot about in your videos is how you just want to serve patients, and you talk about doctor-owned hospitals. As we think forward-looking, as we don't just look at the horrors of the insurance industry, you've thought about how it should operate. How should it operate?

Potter 

Thanks for asking that. I'm an American, and we have not had a single-payer system. We haven't had universal health care in the US. And I'm also someone who really believes in competition and in the market. Those are values that are really dear to me. I think what we need is more competition in the market. When the Affordable Care Act was passed, it did some amazing things. It truly did, but it gave too much power to hospitals and insurance companies, and it took power away from physicians. And one of the major ways it did that was by saying that physicians could no longer own hospitals. So I think there are some really easy things that we can do, some clear steps that we can take. We can allow physicians to own hospitals and apply pressure in the marketplace. We can allow physicians to develop products that are like insurance products. For me, it's all about restoring balance. I recognize that unless we have universal health care, there will be a marketplace where we're dealing with the tension between making money and taking care of patients. But right now, we've shifted far more towards making money—too far in that direction—and doctors no longer have the power to speak out. So, yes, I would say, give doctors the ability to own facilities. Restore our ability to compete in the marketplace. We need to do small things like get back to increasing the reimbursement from Medicare. Doctors reimbursement per RVU (Relative Value Unit) has gone down and down even as inflation has gone up and up. I think there's also a model for direct care, which is a way that we can sort of get the insurance companies out of the negotiation and deal directly with employers. So there are plenty of things that we can do.

I know people disagree on this point, but I really do feel like it's time for the government to step in, in the same way that when a company that makes airplanes makes a plane that hurts people, the FAA steps in and says, okay, enough's enough—we're going to do some things right now. And I'm not saying that the insurance industry has to be regulated forever and always in a heavy-handed way. But right now, I think it's time that the government steps in and says, okay, enough's enough. People have been hurt. We've heard all the stories. We're about to have a doctor shortage. Nobody wants to be a doctor anymore. Let's stop this and impose some actual penalties that have teeth.

So recently, we saw this discussion of prior authorization reform. There was a press conference that was held by HHS and Secretary Kennedy, and they said, these insurance companies have voluntarily agreed to reform the prior authorization process. This was two months ago or something. But there were no teeth behind it all. It was just for show. There's no penalty. So they're acknowledging—they're saying to the American public—we have a big problem. We see it, guys, we see it, but they're not following it up with with something that that will actually have rules and regulations and stipulations and penalties. So I think that's where we need to land next.

Transcript edited byPatrick Farnsworth.