'A new horror story comes out': How healthcare insurers have gone into 'full-on villain mode'

16 Jan 2025, 10:25 by https://www.facebook.com/17108852506 · AlterNet

U.S. Navy Lt. Gail Evangelista, nurse, assigned to Naval Hospital Rota, Spain, dons a facemask prior to interacting with a patient at the Michaud Expeditionary Medical Facility (EMF) at Camp Lemonnier, Djibouti, April 16, 2020. (U.S. Air Force photo by Senior Airman Dylan Murakami)
Alex Henderson
January 16, 2025Personal Health

The fatal shooting of United Healthcare CEO Brian Thompson and the indictment of suspect Luigi Mangione on multiple charges are bringing considerable attention to the practices of health insurance companies in the United States — practices that, many doctors and medical experts say, are egregious, abusive and dangerous to the wellbeing of patients.

One surgeon who is speaking out is Austin, Texas-based Dr. Elisabeth Potter, who revealed she was in surgery with a breast cancer patient when she got a call from a United Healthcare representative. The patient was under anesthesia, and Potter had to leave the operating room in order to talk to the United employee — who wanted her to justify keeping the patient hospitalized overnight.

Potter revealed, "So, I scrubbed out of my case, and I called UnitedHealthcare — and the gentleman said he needed some information…. Wanted to know her diagnosis and whether her inpatient stay should be justified."

In a scathing opinion column published on January 15, The Guardian's Arwa Mahdawi argues that Potter's horror story shows that health insurance companies have gone into "full-on villain mode."

"Just when you think you can't hear anything worse about the insurance industry," Mahdawi laments, "a new horror story comes out. There's been an uptick in stories about insurers limiting coverage of prosthetic limbs and questioning their medical necessity, for example…. And last week, a plastic surgeon called Dr Elisabeth Potter — a specialist in reconstructive surgery for breast cancer patients who have had mastectomies — went viral on TikTok for claiming she had to step out of an operation, where another surgeon was also present, because a health insurance representative demanded proof it was necessary."

Mahdawi continues, "According to Potter, her patient was under anesthesia when she got an urgent phone call from UnitedHealthcare while in the operating room…. Potter explained to the insurance representative that her patient had breast cancer — something he apparently didn’t know because someone else in a 'different department' had that information. This is why health insurance executives get paid so much money, you see. They structure their companies in complicated ways that mean you have to go through at least 50 different people in different departments to try and sort out a claim; in the end, a certain percentage of people just give up because the process is so laborious."

Potter's "horror story," Mahdawi emphasizes, "is yet another reminder of just how frustrated everyone, from doctors to patients, is with the profit-driven health insurance industry in the U.S."

"Yet, despite this palpable anger, there seems to be no appetite by those at the top to change the system," the Guardian columnist observes. "Indeed, it looks likely that Donald Trump's administration will shrink Medicaid — a government system which helps low-income people access healthcare at a reduced cost or for free — and insurance companies will up their use of AI to deny coverage."

Mahdawi continues, "Mangione should absolutely be facing consequences for what he is alleged to have done, but there should also be more legal consequences for those pushing predatory health insurance practices. Killing people with paperwork instead of a gun doesn't make you any less of a murderer."

Arwa Mahdawi's full column for The Guardian is available at this link.