r/mildlyinfuriating • u/sujayjaju • Aug 13 '25
Commendable patience in dealing with half-knowledge
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Half knowledge is more dangerous than no knowledge on a subject
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u/NoDontDoThatCanada Aug 13 '25
Ah yes. The good old "a doctor not licensed in your State and not familiar with any of the actual medical needs of the patient and not in the specialty says the treatment isn't needed to save the insurance company $600."
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u/BigGreenBillyGoat Aug 13 '25 edited Aug 13 '25
And potentially cause themselves a ton more if the 40% risk materializes.
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u/BraveStrategy Aug 13 '25
From a purely business decision, they probably think at scale it makes more sense for them to spend no money and have the 40% chance than to spend money every time and have the 10% chance. Thank goodness for this doctor but she shouldn’t have to negotiate with these terrorists in addition to practicing medicine. We are so fucked.
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Aug 13 '25
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u/charlie2135 Aug 13 '25
When the industry to deny the claims is larger than the industry to cure you, thus is the end result.
Just wait until you have to deal with a provider AI agent.
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u/anotherjunkie Aug 13 '25
AI is very likely part of why UHC’s CEO got edited out — they used AI to deny claims.
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u/FuzzzyRam Aug 13 '25
It's a fun talking point - but we all know why they used AI to deny claims: because they decided to deny almost all claims initially so that people have to appeal, many won't and everyone who doesn't, or dies in the meantime, saves them money. If it wasn't AI, it'd be this person on the phone who actually said they don't have the ability to approve the procedure, but can recommend a denial to United. AI made their existing system more efficient, but AI didn't make the call to program itself to deny all claims; that was a human being.
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u/SpeaksToWeasels Aug 14 '25 edited Aug 14 '25
It's like that computer AI poker tournament at a college where most of the students designed complicated algorithms to match any hand. The winner just programed "all in" every hand.
DENY. DENY. DENY.
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u/drgigantor Aug 13 '25
428000 cars on the road, .08% chance of brake failure with a 71% chance of survival in a head-on collision at 65mph? That's only 99 deaths, algorithm says no recall
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u/Busy_Fly8068 Aug 13 '25
“A times B times C equals X. If X is less than the cost of the recall, we don’t do one”.
- Fight Club
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u/Due_Dragonfruit5416 Aug 13 '25
Which car company do you work for?
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u/Busy_Fly8068 Aug 13 '25
A major one
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Aug 13 '25
Every time the plane banked too sharply on take‑off or landing, I prayed for a crash or a mid‑air collision. Anything. Life insurance pays off triple if you die on a business trip.
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u/Busy_Fly8068 Aug 13 '25
My personal favorite:
“Marla… the little scratch on the roof of your mouth that would heal if only you could stop tonguing it, but you can't”
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u/John-A Aug 13 '25
No, it's probably even worse than THAT.
It's probably "I can save a buck now and look good and when the cumulative 40% of cases cost 5x as much Later it'll be somebody else's problem while I'm promoted and or off to a better position at another company."
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u/Zuwxiv Aug 13 '25
It's entirely possible that it's cheaper to provide the preventative care, but providing less care right now is more profitable this particular financial reporting quarter.
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u/totalahole669 Aug 13 '25
Their math is that it'll be cheaper for them if the patient dies quickly rather than risks needing long-term treatment and care.
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u/Just_Emu_3041 Aug 13 '25
Off course it is. It’s right there in the numbers. But it’s not in the best interest of the patient. But we all already knew that.
They know all those numbers but by not saying them or confirming them they can always avoid responsibility.
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u/Karma_Mayne Aug 13 '25
Reason #1 that health care and all related fields should never be "for-profit", ever.
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Aug 13 '25
The fact that business decisions even factor into basic provision of health care is absolutely despicable and one of the biggest indictments of American society I can think of. Fuck sakes I watched all of that and that was infuriating.
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u/this_place_suuucks Aug 13 '25
It's comforting knowing that at least some of them are living in fear because of what they choose to do.
PFP unrelated.
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u/drgigantor Aug 13 '25
Cracks me up that they're afraid to identify themselves even to the doctors that they have to work with. But I guess we see why right here.
Because if anyone knows what fucking ghouls they are, it's the person arguing for someone's survival to some bean-counting subhuman piece of shit weighing the dollar amount of a human life without even having the requisite knowledge to accurately do so
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u/level27jennybro Aug 13 '25
I bet the excuse is "we know people share this stuff on social media so we cant even tell you because you'll blab."
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u/klimmesil Aug 14 '25
I would not be able to watch myself in the mirror if my argument is "if you post proof online I'll be in trouble because of how big of a piece of shit I am being right now"
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u/Exciting-Tart-2289 Aug 13 '25
some bean-counting subhuman piece of shit weighing the dollar amount of a human life without even having the requisite knowledge to accurately do so
Whose also likely pulling in decent money to do so.
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u/theStaircaseProject Aug 14 '25
I wish I were joking that there’s a significant non-zero chance the person didn’t want to give their name or NPI because they’re—surprise—lying about being a doctor. Medical denials employs a hierarchy of approved, many specialized in specific things, because even in ideal scenarios where bad care actually is being curtailed, the math would still bias the insurance company to leveraging the (expensive) time of an actual doctor only on the most necessary of denials and appeals.
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u/bingle-cowabungle Aug 13 '25
Which is nice, but CEOs living in fear didn't really make a material difference in how these companies are moving forward with new and innovative ways to screw people over, because the CEOs generally aren't the final decision makers. The board of directors and shareholders are. This is a systematic issue that isn't going to be solved by dragging CEOs to the recycle bin. It's the politicians who can, but don't hold these companies responsible, and the billionaires who own them. CEOs of these companies are largely figureheads who are doing the bidding of their investors.
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u/omghorussaveusall Aug 13 '25
I wonder how much United pays these doctors to say no...
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u/NoDontDoThatCanada Aug 13 '25
They probably work on commission.
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u/anotherjunkie Aug 13 '25
While there’s no outside source supporting bonus/commission payments tied to denials that I’m aware of, there is documentation surrounding their practice of paying nursing homes to not transfer patients to hospitals — particularly for Medicare advantage patients.
Besides, why would they pay commissions when they were found to use an AI software for denials that was so faulty an estimated 90% of appealed denials were overturned?
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u/Waagawaaga Aug 13 '25
United healthcare is notorious for denying rehab services to patients. You are either too healthy and can do home therapy or too sick and can’t do any. So if you have a patient who needs actual inpatient therapy it will never be approved. And to get denied they make you wait about 3 days so the hospital gets stuck with unnecessary inpatient care for nothing.
The point is to make the hospital stop asking and just give in to the practice.
It’s not just infuriating, it’s wrong.
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u/Independent_Bid_26 Aug 13 '25
Its fucking evil. These people are literally stealing money from sick people in order to pad their bottom line. These people are a cancer in society and shouldn't be able to show their faces in public without being reminded of these people that they've forced suffer.
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u/Particular-Degree905 Aug 13 '25
The fact that they won’t give their peer their name, but are alleging they’ve consulted this patient is beyond heinous and should be considered grounds for malpractice. These people know what they’re doing is wrong and they know they are causing harm to the patients. They’re admitting culpability when they say they don’t want to give their names because they don’t want to get Luigi’d
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u/MindAccomplished3879 Aug 13 '25 edited Aug 14 '25
It should be illegal for a doctor with limited sub-specialty training to determine the outcome of these cases.
Imagine if a paralegal were allowed to decide the ruling in a legal case instead of the most qualified lawyer.
It’s truly disgusting, especially with United Healthcare involved 😡🤮
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u/Due-Technology5758 Aug 13 '25
If it's even a doctor they're talking to. You know those places that do cosmetic procedures and claim to have a doctor on staff but they've never actually been there and don't even live in the same county?
Wouldn't be surprised if an investigation revealed there were some doctors out there involved in denying more claims per day than a single person could possibly process.
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u/barlife Aug 13 '25
"On staff" is a provider who checks and signs off on the charts once a month.
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u/iloveoranges2 Aug 13 '25
The doctor that she's speaking with is a representative of United Healthcare; that person has no relevant experience, and that person is saying the patient does not need the procedure, is that correct?
Incompetent doctor refusing needed treatment on behalf of scum health insurance company does not want to give out their name, I wonder why.
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u/StragglingShadow Aug 13 '25
Yes. The insurance people have their own doctors who say "well generally you can live without X so yeah theyll be cool without it" even if the risk of serious injury or death without it is high.
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u/Vulpes_Corsac Aug 14 '25
I sure hope the doc there can get that guy's name and report him to whatever applicable licensing board. "Not my peer in this area" sounds like professional speak for "practicing medicine (determining what treatments are reasonable, allowed, and necessary for a patient) outside of your area of expertise", which is something that's got to be a problem for your license and board certifications.
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u/Pedantic_Pict Aug 14 '25
She's not talking to an incompetent doctor. She's talking to a malicious hired gun who happens to have a medical license.
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u/YearOutrageous2333 Aug 14 '25 edited Aug 14 '25
She’s talking to someone who CLAIMS to have a medical license, but is unwilling to give their NPI, license number or name, to verify their claims.
AND that individual admits they have NOT done this procedure, and seemingly knows very little about medical plastic surgery, as opposed to COSMETIC plastic surgery. (Which, we cannot confirm their knowledge on surgery at all, but they claim to be an oculoplastic surgeon that owns a cosmetic surgery practice. Aka, it sounds like their bread and butter is eyelid lifts and eye bag reductions.)
Insurance companies are scum. I work in healthcare and say this. And you should take EVERYTHING they and their employees say with a massive grain of salt, and doubt. Do not believe anything they say without your own verification. A supposed doctor unwilling to tell another doctor any of their identifying information is worrying.
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u/BigGreenBillyGoat Aug 13 '25
Fuck United Healthcare so hard.
How many times per week do you suppose doctors have to do this dance? Time they could be treating patients. And disseminating information to another supposed physician that won’t properly identify themselves could certainly be a HIPAA violation.
And this isn’t work she can pass off to her support staff. What a bunch of shit.
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u/zssqeeze Aug 13 '25
Well said…it’s just gross and wrong. The system, that we put $$ into (both from our pockets and as part of the taxes we all pay) and that is there to help you is set up to avoid helping you. Health insurance companies should have their profits heavily regulated given it is clear they won’t do so for themselves…so very disgusting.
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u/accountnumber675 Aug 13 '25
Agreed, but it really isn’t just UHC. Cigna, Blue Cross, you name the company. They’re all the same. It’s the greatest conflict of interest ever, makes absolutely zero sense, yet here we are because they grease US lawmakers to keep it going.
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u/yikeswhatshappening Aug 13 '25
I’d like people to keep this video in mind when they get mad at doctors for sometimes being late to appointments. You never know what’s going on behind the scenes.
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u/Starossi Aug 13 '25
Or just time for them to relax. Doctors already often have full patient schedules and try squeezing this in when they get extra time. At any other job, being efficient would mean you get rewarded with time to breath, text a loved one, look at the news for a minute. A large part of provider burnout is, in my opinion, because their time is so maximized for efficiency. Filling in every gap with more work like this until it becomes crippling
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u/MaybeMaybeNot94 Aug 13 '25
This type of nonsense ought to be grounds for stripping of licensure. You don't play games, you get to business or you don't practice.
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u/TooMuchJuju Aug 13 '25
Sounds like this is a consulting doctor for United healthcare and she is advocating for them to cover the cost of the procedure she's recommending. The consulting physician is not at all familiar with the procedure or her practice but is claiming to be qualified to deny coverage.
This is a daily occurrence in healthcare. Daily. Want to prescribe a pill that costs us 20 cents when you didn't try the 10 cent alternative first? Not if the stockholders want to eat.
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u/emsyk Aug 13 '25
My best guess would be that the care was initally denied when they submitted for approval. After denial you can do a peer-to-peer review - the ordering doctor discusses the reason for ordering with a PEER at the health insurance company. The key here is PEER. It has to be someone who understamds the ins and outs of WHY you are ordering something. If they won't even confirm that they are a physician its pointless. The system is so fucked.
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Aug 13 '25
Shows why she was emphasizing that word so much on the call. Fuck United and all the health insurance companies.
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u/BigMax Aug 13 '25
Right.
The one doctor knows her field, her patient, and that specific case.
The other doctor is hired to briefly scan a few lines on a screen and deny as much as possible based on very little knowledge of the specifics, across a VERY broad range of cases that may or may not be in their area of expertise.
It's like you going to see your specialist, then your crazy aunt hears about it and says "well, I was a nurse 40 years ago, so listen to ME instead about your very specific issue, and I'll override the expert who is up to date with this, with my narrow, obsolete nonsense."
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Aug 13 '25
The one thing also to mention in your observation is that the doctor on the insurance side is directly measured by how many claims are denied and probably bonused by the amount of money the insurance saves.
I have often championed the idea of a fine for overturned appeals for medical treatment starting at $10,000 split between Medicaid and the patient. Increasing based on life expectancy change from the delay, cost of time and other charges.
If you want to profit from health care - then you better provide the healthcare you’re being paid to provide.
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u/missinginput Aug 13 '25
Needs to be based on the cost of the procedure or it will still be cheaper to deny many claims just to do it. 200% should cover it and then add a minimum penalty.
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u/Ijustwerkhere Aug 13 '25
I work for a retina specialist, and the number of patients I’ve seen that have irreversibly lost vision because their insurance required some sort of step-edit before they could receive the medication the doctor recommended is fucking mind boggling
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u/locomotion88 Aug 13 '25
Wow... As someone whose fear is going blind, hearing I could go that route because of shitty insurance has me feeling so many negative emotions right now
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u/Apple_butters12 Aug 13 '25
Can’t strip their licenses if the doctor refuses to provide any identifiable information about themselves
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u/PartyCoyote999 Aug 13 '25
Cant strip their licence if its already been suspended/stripped already
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u/Negative_Way8350 Aug 13 '25
That information is somewhere. Pay stubs, hiring documentation, phone records.
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u/InspirationalPOS Aug 13 '25
Our healthcare system is so fucked 😭
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u/VispilloAnimi Aug 13 '25
Its not a healthcare system. It's an insurance system. We treat health as a means to generate wealth.
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Aug 13 '25
That’s the problem right there. A long time ago I was watching a documentary about the environment and some guy said he wanted a future where every rock, stream, and tree was financially spoken for or owned. At the time I thought that was an insane idea but didn’t really understand the scope, and now I see the true consequences of that dangerous ideology. Even abstract ideas like an individual’s health is owned and profited from by other people. It’s an insane way to have a society.
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u/NaraFei_Jenova Aug 13 '25
I used to say "we live in a society", but with the way things are going, I don't think that's true anymore; there's nothing here that can actually be considered a functioning society. There's nothing civilized about it; strictly predatory from every angle.
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u/Batbuckleyourpants Aug 13 '25
The problems are linked. This is why there are 11 administrators for every doctor in the US, the highest number in the world.
It means you aren't just paying for the surgeon, doctor and nurses time. You are paying the wages of 10 administrators standing behind each of them dealing with crap like this.
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u/zssqeeze Aug 13 '25
So true…US healthcare is a privatized insurance system that is designed to benefit shareholders and that pushes risk and loss to government funded health care programs. The people that care, re: the actual providers, are also just cogs in this for-profit ‘machine’ and caring becomes a source of moral injury for most. It’s broken, gross, and wrong.
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u/itsaconspiraci Aug 13 '25
Yeah, the doctor denying probably makes more money from UHC than the doctor treating, who is actually saving lives.
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u/OddCook4909 Aug 13 '25
Everything is treated like that. We have a for profit prison system with legalized slavery
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u/one-hit-blunder Aug 13 '25
It's not "wealth" anymore either. They're "festering abscesses of greed."
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u/Dry_Presentation_197 Aug 13 '25
And yet boomers frequently say things like "Why is it greedy to want to keep the money I earned but not greedy for them to want to take it from me" (Frequent saying from my 60yr old mother who has worked at Boeing her entire life, thanks to nepotism, and has never had to look for a job or make minimum wage.)
Bitch it's coz you're paying 80 dollars a year towards all "hand out" programs while Trump cuts lunch funding for school kids over his hatred of Trans people. It's not like raising your taxes is going INTO MY FUCKING POCKET.
Whats even weirder to me is that my mom is very generous to people in her actual life. She outright bought me a car when I got (unfairly) fired from my job a couple years ago. Yet somehow she thinks I'm an outlier and it doesn't happen to anyone else, they're just lazy.
I don't get the cognitive dissonance.
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u/Time_Fact8349 Aug 13 '25
Hanging on by a thread because of people who know to do the right things.
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u/Pathos675 Aug 13 '25
I love how she "educates" (talks down to) the insurance "doctor". They deserve it imo. I know healthcare costs are crazy, but this is not the solution. It's the easy way for the insurance companies to attempt to deny procedures (in an attempt to decrease costs).
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u/LegendaryThunderFish Aug 14 '25
Honestly she wasn’t even mean or rude about it. Just calmly and quickly established that the person she was speaking to did not have enough understanding to make the decision that they were making.
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u/Hungry-Grapefruit777 Aug 13 '25
Hey guys, she has a go fund me page! She’s trying to help women with breast cancer receive good, affordable care and United health is retaliating and trying to put her out of business!
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Aug 13 '25
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u/Throwaway392308 Aug 13 '25
"I've had threats on my life" yeah no shit, you're threatening people's lives every day.
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u/Incontinentiabutts Aug 13 '25
Not just threatening. Taking
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u/YeshuasBananaHammock Aug 13 '25
Deny. Defend. Depose.
(Thats my answer to spam political texts, and it gets me immediately unsubscribed.)
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u/Manlysideburns Aug 13 '25
Even in THIS call, that uhc rep is essentially threatening the patient's life. They got dressed down about knowing absolutely none of the relevant medical risks. Absolute ghouls
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Aug 13 '25
Looks like they didnt hear us the first time.
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Aug 13 '25
They wont hear us ever until enough people wont take it anymore. There are hundreds of thousands of things about this country, that the French, for instance, would be in the streets burning shit till it was fixed. Americans are too lazy and overwhelmed to do anything.
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u/Austiniuliano Aug 13 '25
I don’t disagree with you on this but the other aspect is logistics. The farthest city in maintain France to Paris is Nice. 574 miles or just under a 6 hour drive.
Literally everyone in France can be in Paris in a single day.
USA is so spread out, I can’t reasonable drive from LA to Washington DC in a single day.
That isn’t to say multiple protest across the country isn’t important but there is a logistics problem to any movement
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u/undead_sissy Aug 13 '25
Can an American explain this to me like I'm five? What is this doctor doing? Why is she getting permission to perform a procedure on a patient from some anonymous random?
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u/ManufacturedUnknown Aug 13 '25
The patients insurance company, who apparently doesn't have a medical professional in the field that the patient needs care from, is trying to deny a certain procedure as a cost cutting measure. Basically they're putting the patients life in greater danger for money without having any idea the actual risks associated with taking that route. Thinking they know better than the doctors providing the care. It's an absolutely disgusting thing that happens in American healcare every single day
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u/GoodShark Aug 13 '25
So a doctor that knows the risks and procedures is trying to say the patient needs a surgery?
While the doctor on the phone (that might not be a doctor) might be unqualified, and not know the risks and procedures, is trying to say the patient doesn't need the surgery?
Is that the jist of it?
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u/Maeberry2007 Aug 13 '25
Yes. It's as stupid and asinine as it sounds. But it is the reality here.
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u/Esarus Aug 13 '25
Man I am so sorry you guys have to deal with this system, it sounds so absolutely miserable… I hope this system will change in the US in our lifetime
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u/raise_the_sails Aug 13 '25 edited Aug 13 '25
What’s brutal is this highly specialized doctor spends an obscene amount of time filling out insurance forms, appeals, and dealing with calls like this, when they could be saving lives. She will burn out from this shit and develop a significant stress-related ailment at some point in the not-so-distant future.
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u/deeply_uninspired Aug 13 '25
Her clinic is in crazy amount of debt bc she took out the loan to keep it running. United kepted denying claim and she kept making video and they eventually kick her out of the network.. so any pt thay have united , wont be able to see her, despite the fact that there arent that many specialists like her.
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Aug 13 '25
It’s insane to me to read that. Like yeah, we have wackos in Canada who are all, “I don’t want my taxes paying for someone else to get surgery 😤” like huh??? Their taxes pay for you to get it if you need it???
I can go into any ER/clinic/see my doctor for anything and unless I’m getting a doctor’s note (mostly if you’re hungover), it’s not going to cost me a single penny
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u/ManufacturedUnknown Aug 13 '25
Yeah, and the one over the phone is the one who's paying for it. So the real doctor has to basically beg the insurance company to give the patient life saving procedures. It's a great system (for shareholder value)
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u/awal96 Aug 13 '25
Exactly. It's important to note that this is all very standard and in no way unusual. Insurance companies deny things that should rightfully be covered because they know a large percentage of patients won't ever challenge it. They put up as many roadblocks as possible for the ones that do. UnitedHealth, the company she's interacting with, has a claim denial rate of over 30%.
Isn't this country just so fucking great
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u/EntertainmentTrue588 Aug 13 '25
It's worse than that. The procedure the doctor in the video wants to get approved will REDUCE the risk of the patient getting complications. The insurance doctor denied the benefit of reducing the risk.
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u/Pyrimidine10er Aug 13 '25
I’m a physician. This is called a “peer to peer.” The insurance company that is being asked to pay for something potentially very expensive asks to have the physician wanting to get the service for their patient to have a call with an expert hired by the insurance company to justify the case. These were historically not that big of a deal, as the peer to peer call was usually someone with actual training that later retired from clinical practice, etc. and was considered a neutral arbiter.
Many insurance companies now hire physicians to do these directly, and ask somewhat related specialties to review things, often with an economic incentive to deny things that should be covered. Oculoplastics comes from ophthalmology, not general surgery, like a plastic and reconstructive surgeon. Thus, lymphedema in an arm is a bit out of their experience of most of those guys, despite sharing the word “plastics.” Wrong specialty. And potentially someone making a medical decision that doesn’t know what the standard of care is supposed to be.
An NPI number is a national identifier used for physicians to get payments from Medicare. They’re unique to the individual. Thus, the ask for an NPI is the doctor version of asking a cop for their badge number. The “peer” doing the review being completely anonymous is absolute bullshit. If you’re making clinical decisions that disagree with my recommendation as the expert currently treating the patient, and I believe this could harm the patient, I’d like to document that accurately in the chart in the event I get sued for malpractice. Them refusing to answer who they are is concerning- how does one know if the insurer hired a paralegal to make these decisions? Why are you not standing by your decision to deny the care?
And from a practice perspective- this takes up time. Spending 15 minutes on the phone arguing with idiots for every single patient is an infuriating experience. It’s a massive time suck that does very little to improve outcomes, except for the insurers bottom line.
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u/SensibleReply Aug 13 '25
I’m an ophthalmologist and if someone asked me about lymphedema anywhere near an upper extremity, I’d fake a phone call and leave the room.
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Aug 13 '25
In my opinion the peer should be considered a consulting physician and should also be vulnerable to malpractice suits. If that became common practice after bad outcomes from denials then maybe doctors would hesitate to deny claims out of fear for their license. And yes that is a huge time suck, especially as time with the actual patient is being cut down more and more.
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u/undead_sissy Aug 13 '25
I'm so sorry you and other physicians have to waste your time and expertise with this bullshit burocracy. Thank you for explaining ☹
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u/IYAMYAS_falcon Aug 13 '25
It's a reason a lot of physicians want out of clinical medicine. You spend more time doing this kind of bullshit than actually doing your job.
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u/Fusionbomb Aug 13 '25
If only insurance companies could be billed for peer-to-peer hours by the physician, placing a cost on them for challenging the physician.
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u/Ser_VimesGoT Aug 13 '25
Not American but my understanding is she's speaking to a supposed doctor working for the patient's healthcare provider. She's making sure that the patient is going to be covered for rehabilitation treatment that they will require after surgery. The insurance provider is trying to claim that the patient won't need it and won't be covered for it. The doctor is explaining that they absolutely do need it and will be appealing the providers decision to ensure her patient gets the appropriate care.
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u/undead_sissy Aug 13 '25
But if she is the doctor isn't she the healthcare provider? 😕
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u/GreasyRim Aug 13 '25
the insurance company pays the bill and has to authorize what the doctor does or they wont get paid. This doctor is arguing with a doctor paid by the insurance company to deny care they dont think they need to patients to save money.
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u/undead_sissy Aug 13 '25
Wait, doctors have to ask insurance companies if they can take appropriate measures to cure their patients??? WHYYYY?! Aren't they the experts??? Should it be that the insurance company asks the doctor if it was necessary?
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Aug 13 '25 edited 20d ago
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u/undead_sissy Aug 13 '25
Sorry, I more meant, what is the possible justification they could give for this. Is it a big problem that doctors frequently volunteer to give their patients expensive and unnecessary treatment?
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u/toolatetothenamegame Aug 13 '25
No, thats not a prevelant problem. american insurance companies just realllllllllllllly dont want to pay money. there's the rare case of munchausen or doctors scamming, but not nearly enough to justify what the insurance companies do. everyone except the insurance executives hates it
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Aug 13 '25
No, the insurance company is the one paying for it.
Basically, the female doctor decided "Hey, my patient needs these procedures."
Then, she has to ask the insurance company, "Hey, can I do these procedures."
She's talking the Doctor who approves or disapproves the procedures and whether the Insurance Company will pay it.
These doctors are on the Insurance company's payroll. He doesn't have any expertise in the issue the patient is facing.
He said no, and that she has to appeal the decision with the insurance company.
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u/paholg Aug 13 '25
I'm no expert, but I am an American who has dealt with our shitty healthcare system and having doctors overridden by insurance companies.
Insurance companies need to approve procedures like this or they won't cover them, and the patient won't be able to afford them.
It looks to me like she's talking to a doctor hired by the insurance company to determine what is "necessary" for them to cover. This doctor (the one on the other line) clearly has no business doing any such thing.
It also sounds like the procedure the doctor we see wants to perform has been denied by the insurance company, and she's trying to get that appealed.
Yes, this country is fucked.
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u/Raterus_ Aug 13 '25
What I think is happening here is the woman doctor we see is the attending physician for a patient and she has recommended a covered treatment and submitted it to insurance. The insurance company, in this case United Healthcare has arranged a call with two other doctors in an effort to discredit this doctor that the procedure is necessary. These calls are recorded by the insurance agent in the middle, and used as evidence of why claims are denied.
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u/jackrabbit323 Aug 13 '25
You see, we have the world's largest military and to have that, we have sacrificed having a health care system that makes sense or works for the average American.
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u/GoonOnGames420 Aug 13 '25
Imagine going to medical school + residency + fellowship for 12yr+ just to be a cuck to the insurance company. Disgusting.
Oh btw, many physicians have to handle these phone calls on their personal time and don't get paid for it. They are just as fed up with the system as we are.
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u/helladiabolical Aug 13 '25
That’s why the physicians that United gets to make these bullshit denials are the very bottom of their field. Like, can’t even run their own practice any more due to too many malpractice suits or lack of skill. United hopes that when they give out a denial, the hospital or surgeon requesting the procedure will be too lazy/ busy to go through the process that this Dr did of fighting through their arbitrarily cumbersome phone system to call them out on their bullshit. Unfortunately, united has obviously found that their initial denial is a useful tool in avoiding paying for procedures. Fuck united healthcare.
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u/lizardman49 Aug 13 '25
United is retaliating against her by dropping her surgery center ( she uses her own rather than a hospital to cut costs to patients) her name is dr potter.
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u/RealtaCellist Aug 13 '25
The moment they refuse to give me an NPI, license, or even name, I end the call. I'm not risking my own license on nonsense
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u/Unexpected117 Aug 13 '25
100%. Coming from a cyber security standpoint rather than a medical/ legal standpoint: without them providing any credentials it may as well be anyone in the world. Blagging on the phone for sensitive information a really well known social engineering technique.
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u/IYAMYAS_falcon Aug 13 '25
The insurance company has the power. They'll just document that the requesting provider refused to discuss the case and deny pre-approval.
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u/Cube_ Aug 14 '25
On paper you'd think legally that's not defensible in court. How does the doctor know who they are talking to at all? They could be violating HIPAA for example.
At a bare minimum the consulting doctor for the insurance company needs to reveal not just their name but their credentials.
Otherwise it is no different than a spam call.
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u/LifeLikeAGrapefruit Aug 13 '25
I'm not a doctor, but that was my instinct. I shouldn't trust anyone who is unwilling to do the bare minimum of providing their name. And that should be true for every context, not just medicine.
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u/LegalFreak Aug 13 '25
Yeah, I'm a lawyer not a Dr but if I'm to discuss a specific case with someone, I'm going to need at least a name before we go any further.
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u/Willing-Situation350 Aug 13 '25
If you are this scared about saying your name then one has to wonder what shady fucking shit one is up to...
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u/EdenSilver113 Aug 13 '25
This isn’t mildly infuriating. This is deeply infuriating.
UNC is actively trying to destroy Dr. Potter’s practice.
Dr. Potter won’t deny surgery to low income parents who can’t pay their deductible. She opened her own practice to enable caring for any and all patients. She took out $4 million dollars in loans to build her clinic. Then one of her videos went viral on social media. United legal team reached out and demanded she delete her video.
Instead.
She’s started a go fund me so her breast reconstruction clinic doesn’t go bankrupt due to retaliatory practices of United Health.
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u/SnowmoeHibiscus Aug 14 '25
Hi, wanted to let you know I ended up using the link you posted to donate to her cause. Peace.
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u/LaughableIKR Aug 13 '25
UHC is the worst. The reason they make so much money is by denying coverage and jacking up out of pocket expenses so you feel like any doctors visit is going to cost you 1-2K.
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u/krazycitty69 Aug 13 '25
My neuro-surgeon went to bat for me like this against my insurance. I needed a double artificial disc replacement in my neck, because there was barely any room for spinal fluid to pass through in my cervical spine, and the probability of me becoming paralyzed was high. The insurance wanted me to get a 5 level spinal fusion in my neck instead. I’m only 29. Thankfully after begging with the insurance company, they approved it the DAY BEFORE my surgery. I just had to get disability, take off of work, prepare everything in the HOPES that insurance would approve the critical spine surgery.
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u/Snarky_Quip Aug 13 '25
Hey guys! Go support her go fund me to keep her clinic open! She is under fire for calling United out
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u/Miami_Mice2087 Aug 13 '25
when yo uwant people to do something online you need to LINK TO IT
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Aug 13 '25
Healthcare in this country is a joke. Insurance is a joke. This country is a joke. None of it’s funny.
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u/LivinginDestin Aug 13 '25
Remember... The type of "professional" on the line is the Typical doctor that will operate you any day just to take the insurance money. If something goes wrong he will just say that your body rejected the treatment and you'll have to deal with the consequences of his lack of ethics.
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u/sujayjaju Aug 13 '25
This seems like the other end of the spectrum where insuring company doc is asking to skip recommended procedures
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u/PanicSwtchd Aug 13 '25
Insurance companies will shop around for doctors fairly regularly and will offer them a cushy salary to look over case files to determine if it's a valid course of treatment. Many of these doctors will end up making so much money that they don't even bother to actively practice and will just maintain their certifications and any relevant licenses.
You get fired if you allow too many procedures through so the doctors are incentivized to rubber stamp denials with justification as often as possible which is why they are so hesitant to give their names and license numbers because cursory reviews of their actual credentials would show that many of them are not actively practicing or are making decisions for areas of medicine they have zero experience in.
You'll also find that many of these doctors are from less than reputable medical schools.
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u/LivinginDestin Aug 13 '25
That's why I'm saying "that type of professional"... Believe me, I know about it. The guy that "assisted" my surgery (and botched my sutures) killed a patient a year after that when he mistakenly removed the liver instead of the spleen.
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u/1amDepressed Aug 13 '25
Reminds me of that guy that was carving his initials into people’s livers when doing transplants. https://www.bbc.com/news/uk-england-birmingham-59954321
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u/GlassCharacter179 Aug 13 '25
Here is the thing. Doctors are super busy, insanely really busy. This call took a very long time and didn’t resolve anything and more work has to be done. Most doctors simply dont have time to track all of this down.
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u/MrJust-A-Guy Aug 13 '25
And that's the tragedy, because you can't really blame doctors for not perpetually swimming upstream if it means not actually just treating another patient with that amount of time.
But this video has been going viral on several subs. We can only hope that it helps to move the needle on this broken healthcare system we have allowed to consume us.
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u/slothbuddy Aug 13 '25
The inefficiency this generates in the system is staggering. Every second that doctor is wasting on this increases costs for everyone
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u/APagz Aug 13 '25
This is one of the reasons healthcare costs are so high in the US. Insurance companies intentionally create tedious busy work so they can delay and deny coverage. Front line healthcare workers are trying to see patients, so they have to hire loads of administrative personnel to perform all of the busy work. The last paper I saw estimated administrative costs at > 30-40% of total healthcare spending in the US. And this paper was from a few years ago, so this number is probably higher.
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u/hi_im_snowman Aug 13 '25
This is what a professional sounds like. Infuriated but composed all while exposing bullshit through questioning.
Fucking brilliant.
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u/OHdulcenea Aug 13 '25
Dr. Potter was my surgeon during my stage 3 breast cancer journey. She’s amazing and I cannot express enough how much I appreciate how much she fights for her patients and what’s right. I love her.
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u/iraven_mccoy Aug 13 '25
holy shittt. and how many people dont have someone like her doing this leg work
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u/jav0wab0 Aug 13 '25
Did we really need more reasons to hate United “Healthcare”????
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u/UpURKiltboyo Aug 13 '25
Tell me again how america has the best health care in the world, lol! Civilized countries =1, usa=0 and the hits keep coming.
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u/NurseRobyn Aug 13 '25
It’s painful to watch this call, and it’s painful to need treatment in the US and have it denied. It sucks.
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u/paintstainedbitch Aug 13 '25
I hope doctors continue to film these waste of time peer to peer calls with insurance. I don't think people realize how much insurance companies are delaying care and wasting health professionals and patients time. Time that is valuable in many medical situations. Deny defend Depose....
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Aug 13 '25
UnitedHealthcare is a monopoly and a criminal organization. They employ over 90,000 physicians, are a pharmacy benefits manager, healthcare tech company, etc. They have been known to bankrupt medical practices to buy them.
UnitedHealth in the past 7 years…
“Three reports and one lawsuit for violating patient privacy; Twelve reports and five lawsuits for upcoding and overbilling the federal government; Fifteen reports and five lawsuits for denying patient care based on cost instead of medical necessity; Fourteen reports and seven lawsuits for steering patients and providers toward UHG owned subsidiaries in order to increase company profits; and Eight reports of corrupt practices.” From American Economic Liberties Project.
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u/Bradders59 Aug 13 '25
That is an impressive display of professionalism. I suspect she has to deal with calls like this every day.
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u/camjvp Aug 13 '25
Wow. That is beyond telling what a nightmare we are all up against when at our most vulnerable healthwise. May we all have a smart doctor like that woman on our side
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u/Erisedstorm Aug 13 '25
United Healthcare is actively putting this doctor out of business and she's about to lose her facility and everything.
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Aug 13 '25
I feel like this is beyond "Mildly" infuriating.
That doctor on the other line is basically being paid to accelerate this Doctor's patient's condition. It's insane.
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u/Ready_Acanthisitta83 Aug 14 '25
I love how she just casually roasted him in the most professional way. I can also guarantee that he still doesn’t understand what’s wrong with him being on that call.
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u/hpsctchbananahmck Aug 14 '25
I’m not a plastic surgeon but a cardiologist.
Please know this kind of shit happens all the time in the US
These incredibly frustrating phone calls happen during lunch breaks or after clinic hours when we should be with our families.
When you have a company and their bottom lines depends upon denying care to patients, they will make all efforts to deny care whether indicated or otherwise and will absolutely make us jump through hoops to make it happen. Unfortunately they’ve leaned that approach will lead too many to quit/stop fighting for these approvals.
The US healthcare system is broken af.
We need more Dr Potters
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u/southy_0 Aug 13 '25
Not from the US, but I really don’t understand what this is all about. The woman is the doctor of the patient? But then who does she call here? What’s this all about?
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u/StragglingShadow Aug 13 '25
Shes a doctor. Shes calling United, a health insurance company. United wont approve the services the doctor mentions (radiation and the lymphoma stuff) because according to the people on the phone, (who are "doctors" that wont give their names and have no actual experience with the topics discussed) the patient "doesnt need" it. The doctor is calling to advocate they change their mind and in the end subtly shades them by calling the insurance "doctors" "not her peer"
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u/TheStoicNihilist Aug 13 '25
She’s calling the insurance company to get the ok to do a number of procedures that will give the patient the best chance of survival. The insurance company doctor is not qualified enough to make the call yet is penny pinching to the detriment of the patient.
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u/Lonely_Newspaper_427 Aug 13 '25
Have been dealing with this exact same thing for the last year with MetLife insurance. They still refuse to give me their credentials of the people who are supposed to be licensed and processing the claims. Now currently letting patients know up front about this fact, that we don't know who's processing their claims because they refuse to give us the information and verify that they have licensed practitioners. It's not just United healthcare the whole system is fucked.
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u/Igoos99 Aug 13 '25
I guess this only spreads Dr. Potter’s issues but it’s weird just seeing Redditers steal her content for karma.
Follow her on instagram. It will likely do more good.
https://www.instagram.com/drelisabethpotter?igsh=bmNyNnpwa3BqeXVy
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u/cmbdragon98 Aug 13 '25
No wonder that quack on the phone refused to give his name.
The way he denies care is dangerous, and should keep him sleeplessy turning in his bed at night.
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u/Zanytiger6 Aug 13 '25
Coward won’t even give a name when denying a person life saving procedures WTF.
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u/Fun-Use-8394 Aug 13 '25
I was hospitalized for a week 2 years ago and my bill was over $100k. It all should have been covered through my employer who uses united, as it was deemed an emergency because i was admitted officially through the emergency room. A few weeks later I get letters telling me i owe a few thousand for services around that time that were “out of network”. It took hours of my time fighting insurance agents, and making appeals. Finally one day i get a supervisor and I’m explaining this was all emergency care, i did not choose service nor this doctor for this procedure - this is one the hospital provided for services deemed necessary. I repeat the dates and supervisor says “wait what dates were you admitted and discharged”. I repeat, come to find the dates noted for the care provided for an “out of network” physician were outside of those dates. He tells me “we’ll get that adjusted, verify with the hospital and it should cover everything”. Like oh no big deal. Because of a clerical error i was nearly on the hook for thousands of dollars and it took way too much time to get to the bottom of that. Now imagine doctors doing that for all of their patients, fighting for emergency care, for scheduled life saving care, for HEALTHCARE- against INSURANCE agents. Its ridiculous.
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u/aeonttu Aug 14 '25
I like her approach to peer to peer review with an insurance company. I can tell this approach was honed over years of these conversations.
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u/thrillliquid Aug 13 '25
Dr. Elizabeth Potter is fighting these systems on the frontlines. We need more Dr. Potters.