this is utterly terrifying more than any other news IMO
It’s fucking unconscionable that doctors have to beg insurance companies to fund necessary surgery. The healthcare system in your country is fucking barbaric!
Capitalism is barbaric.
Her name is Dr. Elizabeth Potter, a microsurgeon who specializes in complex breast cancer surgery. And this insurance company is now trying to destroy her reputation & bankrupt her surgery center since she spoke out about their practices. I’m sure you’ll never guess which health insurance company.
In all the other developed nations on earth, universal healthcare makes all of this impossible. The patient would simply get the surgery required, end of story. Sadly, America is different. Good thing it's the wealthiest country on earth, w/the biggest military, eh? That'll offset this nicely.
Perchance?
Dr. Potter has battled not only UnitedHealth, but Clare Locke lawyers aka: attract dog NYT investigation of UnitedHealth www.nytimes.com/2025/07/12/b...
This fight is going on right now. If you want to follow and support her you can find her here: www.tiktok.com/@drelisabeth... The details of what’s happening to her are unbelievable. Or should be.
She's amazing. We also interviewed her this week about that first phone call she got from UnitedHealth that started this whole thing. Thanks for highlighting these stories. www.medpagetoday.com/publichealth...
I really wish people wouldn't use TikTok, and not just because it's a platform that enables China to hoover data, but because it doesn't allow non-users to simply view video in a browser link (as far as I know). YouTube: youtu.be/AZhCYisIQB8
Privacy issues aside, as I agree (although these days YouTube/Google is no better), you absolutely can watch videos in a browser link. I do, as I occasionally have to research stuff, and I don't have a TikTok account. The browser experience is a bit rubbish but it works.
I couldn't get it to work on my phone browser. It's useful to know that someone has been able to do it. I won't give up yet.
Oh. I'm on desktop. Haven't tried with a phone browser. So we may both be right.
If you can go to the settings in your phone browser and turn on a Desktop mode, you can watch it that way. But it's also incredibly annoying in that mode, but at least you can get around needing an account.
Hmmm ... I hadn't tried that.
This is so incredibly stupid. This, THIS is waste. Pure waste in our healthcare system. It simply adds costs to healthcare with no benefit. It explains why we pay $1.5 trillion/yr than comparable countries for worse outcomes. Having a single payer would increase doctor productivity a lot…
… enough to eliminate doctor shortages? Huge opportunity for Dems to run on universal healthcare AND fiscal responsibility.
^$1.5 trillion MORE than
AMEN!!! tho folks say we need the baby step of medicare for all, but that's a wretched option! as a retired healthcare provider i can tell you, from both patient and doc angles, insurance companies have become (predictably) killing machines! medicare STILL forces us to fight with them!!
60-70% of the people want universal healthcare. Solution: Put the market on the SUPPLY side & a single-payer on the DEMAND side. If Democrats learn to talk about both social AND market principles, they will win, and have a long political reign. Comprehensive video: www.youtube.com/watch?v=_-3C...
Medicare 4 All would save money and lives. Profitcare is killing patients. Insurance companies are allowed to legally bribe politicians. Nothing will change until we take money out of politics.
More info on lymphatic microsurgery: “Sutures used during microsurgery are extremely fine—much thinner than the thickness of most human hair… lymphatics are much more delicate & technically challenging than the vessels & nerves we handle in non-lymphatic surgery." www.mayoclinic.org/medical-prof...
For those not on tiktok, more info in this article about the fight Dr. Potter is having to wage to protect her patients: www.thetimes.com/us/news-toda...
🙌🙌🙌
And more here about the strong arm techniques health insurance companies use to try to silence dissent: bsky.app/profile/bgru...
Thank you for spreading the word, Dr Hicks.
Sans paywall: archive.md/SAcf8
I honestly wonder if her "peer" and "expert" knows what lymphedema even is or why bc patients are vulnerable to it.
They know. They are paid to fight it. I deal with denials all the time.
If you listen to the whole thing, it is clear that they are not true peers. I’m not sure which would be worse Claiming unqualified people are peers or qualified peers participating in a shady system. Either way, patient care is failed.
Probably just an chatbot or someone hired to be a cold caller type punching bag for the insurance company.
It's not. It's typically a peer in your field; they're just paid well and encouraged to deny treatment. I deal with this all the time when I try to get some services approved. They just don't give a fuck.
I’ve been on the patient end. It’s agonizing.
It is. Insurance is the bane of clinicians' existence, but we have to take some form of it on some level.
A company that offers private insurance in any context is to me as much a scam as any ponzi scheme. It's impossible to both be profit-motivated and fulfill the obligations operating a risk pool entails. This entire business model is a scam and should be illegal to do. Healthcare is infrastructure
A lot of doctors don't really seem to know what lymphedema is, i've discovered. I was recently "diagnosed" with it by a doctor who had no business diagnosing anything like that and it has been impossible to get off my records and leads doctors to draw all kinds of incorrect medical conclusions.
Including ignoring the actual thing that's wrong with me (which is not lymphedema), i will note, because i the actual problem is rarer and not really a "diagnosable condition" in the same way.
But which is detectable with CT scan, which i've had and it's on my chart that it was detected but doctors would have to read past the list of diagnoses to see that or some shit because i have to argue with every new doctor i see and then they don't believe me anyway.
(But when i talk to specialists they're unanimous that it's this other thing and not lymphedema, which is on my records but also doctors don't seem to read that. They just see this one incorrect diagnosis from years ago and their brains turn off.)
It's funny because i probably now know more about lymphedema, a condition i do not have any particular connection to except through a mistake, than your typical GP.
It stretches credibility that they would not be. Lymphoedema is a very common side effect of axillary clearance in breast cancer surgery - there are people who do this every day (probably including Dr. Potter).
According to her phone call, the “peer” she was speaking to works as a cosmetic plastic surgeon. So, probably providing very few surgical services themself that would be covered by insurance and almost certainly never a cancer related surgery. Maybe some skin grafts for burn victims?
Yup. Which is a category error that (to steelman things) may not be United's fault. Peers here would probably include a vascular surgeon, I guess.
She’s a plastic surgeon, so her peer would be one of the many many plastic surgeons who deal with breast cancer surgery, which is extremely common as you said. Insurance companies play shell games like this as a matter of course. On paper, she spoke to a peer. In reality, they 100% wasted her time.
A doctor who can’t tell her the risk % of a patient developing the exact problem leading her to seek approval for this surgery in the first place is not even prepared in a basic way for the call. They could do reading as preparation for this. If the approval framework was legit, they would be.
Story from the Times of London. You can almost hear the disbelief from the UK that our healthcare system is like this. Dr Elisabeth Potter: I criticised UnitedHealth — now I’m facing ruin share.google/XzyRb4K6zC3L...
I'm a little surprised Bill Ackman has backed Dr. Potter rhetorically and financially. Good for him!
If you shook bill ackman out over a bucket by his foot, you'd get healthcare $$$ for tens of thousands of people. When he relinquishes his wealth to the small comfortable fortune that could sustain him and give his family reasonable security for generations, I would consider an ounce of gratitudem
Even a stopped, broken hypocritical clock is right twice a day
@unroll.skywriter.blue
The thread as a shareable webpage: https://skywriter.blue/pages/did:plc:wpsspp55o7w6muawlnmknobc/post/3luahluqepc23.
Thank you for doing this! I didn't realize it was available here!
There are significant efforts by some in the US and UK to Americanize the health care system in the UK. They’d better know exactly what they’re getting into - so I’m glad an article like this is in their mainstream press. Buyer beware!
The civilised world can't believe how a country that used to lead the civilised world has turned into a demonic evil society and nation.
The US idea of civility is greatly exaggerated.
As someone who grew up and lived here many years, and who has also traveled outside the US, I can say that with one important exception we are no better or worse than people everywhere. The exception is that we tend to think we are better, but even that's not exceptional (looking at you, England).
Luckily, I'm not English. Every country has a history of barbarism and doesn't like to believe so, no doubt, but the US has a unique way of not facing theirs. Making out they are the best country in the World but they don't have universal health care and proper employee rights.
We're fed an obscene amount of "We're #1!!!!!!" propaganda from birth, and a lot of people never leave the country and don't know people elsewhere, so it sticks. It's absurd right on its face, but that's where it comes from. America, it turns out, is a pretty culty place overall.
When I was born we were the best place to live in the world, and for many years after. But we've been going downhill since Reagan, and th EU caught up and passed us. Does any other sane country have a major political party that still espouses the Laffer Curve?
On the other hand, our society tends to be dominated by a faith in "market forces" and capitalism that is simply not borne out by experience. Since Reagan and the 1980s there has been a truly unjustified faith in laissez-faire capitalism and the cruelty of Trumpism is its apotheosis.
I feel weird being on the same page as Bill Ackman.
Weird that the topline includes her being supported by pure evil. I'm not sure anything else would have made me less sympathetic.
@marreta.pcdomanual.com pfvr
🔗 Chapeu de paywall é Marreta! 💣
We have acute awareness here in the UK that private health care providers and insurance companies are doing their best to break our system. And they have some leading politicians in their pockets. When we hear these stories from the US, it's horrifying.
Same thing is happening in Canada.
Soon to come in Germany if Merz gets his way.
And New Zealand if Seymour gets his way.
People all over the world need to stop voting for conservatives.
They're working on it in Canada, too - Specifically starting in Alberta.
Anyone who wants to gut the NHS, just send them over here next time they want to see a doctor. The US healthcare system is designed to surgically remove dollars from patient wallets, and transplant them into the wallets of insurance execs.
I'm not sure that most Americans realize that their healthcare system is used as a boogeyman in the political discussions in Europe and elsewhere. All you have to do is compare someone's health system proposal to the US system and it's immediately unpalatable.
No conservative arguing for cuts and privatization argues, "Yes, we're making it more like the US system, and here's why that's good..." They argue: "No, it's not like the American system, and here's why...." Because the former is a guaranteed loss with the public.
Actually, Canadian conservative do, in fact, argue that, and unfortunately, it doesn't seem to cost them support in large swathes of the country.
I think we realize it's bad. The problem is too many people have been convinced by those who have a stake in it staying bad that changing it would be worse. Obamacare was a very small improvement and it's been whittled back and sabotaged every step of the way.
The people here who want to gut the NHS are wealthy enough to never have to use it.
And it's a flawed concept to go private. As both a patient and an employee, I saw both sides of this. When I wanted to get kidney surgery swiftly, I looked at going private. The cost was immense, the waiting list, longer. And the standard of medical care, far poorer.
Thank you for posting this. I read it all, and donated. I hope the Times continues to follow the story.
A cosmetic surgeon peering for a cancer-specialized surgeon? That tracks.
A person *claiming* to be a cosmetic surgeon. Good grief.
Yep, sure does.
As a breast cancer survivor who experienced lymphatic dissection and radiation, had this procedure been available to me 20 yrs ago, I may have been able to avoid lymphedema, which has been the main long-lasting consequence of my breast cancer. Experts need to be trusted on treatment of lymphedema.
Thank you for this important thread. #medsky #PSA
I did a postdoc in a pharmaceutical sciences department and part of that involves surgeries on animals. I had a friend there who would cannulate lymph ducts to collect lymph fluid. They are so tiny. It's really hard for folks to appreciate how small they are. I cannot imagine trying to suture them.
As a vascular surgeon, I have never tried a lymphatic bypass and never will. They are extremely challenging.
Thank you for sharing. I am now following her on TikTok (reinstated myself for this). This is so important to share further!
Thanks for posting this. I do not have Tik Tok, so please keep us updated. Thanks.
Insurance companies behave this way because they own the politicians.
I’m dealing with same company regarding my mother-in-law’s end of life care from last fall. I’m finding this fascinating, thanks Mar
you can also find her here @drelisabethpotter.bsky.social
📌
Starts with a U? What can we do? Maybe people insured through unions should call our unions and tell them not to offer this option? Also, contact our reps?
She’s amazing! I have had lymphedema for 23 years following exactly the types of treatment she describes on the phone call. Microsurgical techniques were unknown when I had my mastectomy, but there is NO EXCUSE for not having microsurgery nowadays. I spend so many hours a week taking care of my arm!
Thank you so much for sharing shining a light on this is huge for those of us with health issues or loved ones(everyone).
well, she states it at least twice, but even without that, it was clear she was dealing with united health. then i see that she's been under threat because she spoke openly about their horrible practices!!??! as a retired healthcare provider i can tell you, UHC is THE WORST!! relieved that's public!
This is the type of professionalism that should be applauded not attacked.
"trying to destroy her reputation" Hell, this sort of dedication to your patient is the sort of thing we should all be LOOKING for. I hope the positive reaction from decent people outweighs the negative one from the corpos (and I say that as someone who _has_ the same company's insurance).
It's just such BS that a SURGEON, let alone their staff, has to spend so much of their time dealing with FOR PROFIT insurance companies and billing, which takes away time from serving their patients. The American healthcare system is so stupid.
Not stupid. Criminal. Amoral.
Not criminal. System working as intended. Immoral.
And Labour, Reform and the Tories want this in the UK. Labour haven't explicitly stated it but they won't roll back privatisation that has already happened, many of them including Starmer and Streeting have received funding from private providers AND they're hell-bent on austerity.
I hope you guys can fight that off.
I sat next to two doctors at dinner last night and our conversation revolved around the shackles insurance companies put on them. For-profit companies stand between patients and the healthcare they need, yelling “We need our big cut first!”
I suppose it is good to hear that United Health employees are still deeply affected by the death of their CEO, the shits.
I am sure the man (of course it's a man) does big business in Botox
So we have to take the word of anonymous, faceless people claiming to be doctors as “medical advice”; and allow anonymous, faceless thugs to kidnap people off the street for “safety.” Don’t ya feel free??
FYI: Dr. Elisabeth Potter is on Bsky bsky.app/profile/drel...
United “Health Care”.
The curse of working in Healthcare in the US. We just want to help people not financially cripple them for life. Even if you're a total asshole ill do my best to either keep you alive or make you as comfortable as possible in your finals days
Omfg😡😤 So wrong 🤷
I once worked for them as phone support during Medicare Part D enrollment one year. Three month gig not counting paid training. I left after being assaulted on the floor by a supervisor. After reporting him to his supervisor, the answer was for me to sit there while he yelled at me.
If my choice for insurance is UHC or do without, it’s not a hard choice. I’m too proud.
Correct. I cannot guess. It’s unclear that any are better than others.
OMG. This is insane and horrible.
Let's get her over to BlueSky
bsky.app/profile/lizj...
guess the new CEO is not afraid of reprisals
I shared this awhile ago. The link may no longer work. bsky.app/profile/bgru...
I'm glad she's coming forward with this and pushing hard to get her patient the care she needs and pointing out that the decision to deny it isn't being made by experts.
I'm also guessing that Medicare/Medicaid/the VA would approve this procedure and I fully support legislation that would force private insurance to cover anything that insurance from the US government would cover.
Actually, her name appears to be "Elisabeth Potter" with an "S." This hero is no "Liz!" :)
United Healthcare???
We need to start a Go Fund Me campaign for her to support her in this fight against United Healthcare. I thought that after what happened to their CEO, they would be compassionate to people who get coverage through them. Why take money from people and refuse them care? This is criminal
I would really want her as my doctor❤️
So, the insurance company has the money to do this yet they deny necessary procedures.
That’s how they got the money in the first place
My friend has United & is pretty loyal & a bit defensive about it. I've told her the truth about United w no luck.
It's that one that made Luigi well Luigi a CEO.
And then those suits wonder why their CEO was the first one murked. (No one else has been yet, but it’s only a matter of time imo.)
Do you have a link to that letter she got from the law firm in a document form? Cause that's...a lot..of letter.
Sorry no, other than it’s posted on her tiktok.
Yeah I was able to grab it as images. Thanks
What does the letter say?
bsky.app/profile/izzo...
Calling on all attorneys on @bsky.app to do some pro bono work for Dr. Elisabeth.
She’s such a professional I’d not have been able to be so polite. UHC sucks
The best way to appeal a denial is to show that the person who issued the denial either wasn't a doctor at all, or wasn't qualified to make that determination. At least, that used to be the case. This level of obfuscation is just outrageous.
This makes my stomach turn. Absolutely deplorable cowardly behaviour from both United and their 'expert'.
Such an amazing system we have here.
Wow!! Poor Elizabeth could hv been talking to the Janitor of the building!!
@nicki-nous.bsky.social check this shit out babe
If there were no insurance companies, you could just provide the treatment that people need. Seems to me that their primary task is to deny claims and make huge profits. It’s hardly medical care.
What the hell? I worked in the NHS, as did most of my immediate family in one form or another, and anybody who behaved as unhelpfully as that would be in ENORMOUS trouble!
Well see, the literal only job of the United consultant is to stamp deny on 100% of applications for patients who are flagged as "likely to die soon" in United's system so that the person dies (often from lack of care) before United has to pay for anything.
She is speaking to someone who 'doesn't have the ability to approve' the procedure.
Healthcare in the United States is criminal. Healthcare IS A human right. For profit healthcare must be destroyed and universal healthcare must be what Democrats run on. The Democratic Party better get on board and be willing to fight to make this a reality or get the hell out of the way.
60-70% of the people want universal healthcare. Solution: Put the market on the SUPPLY side & a single-payer on the DEMAND side. If Democrats learn to talk about both social AND market principles, they will win, and have a long political reign. Comprehensive video: www.youtube.com/watch?v=_-3C...
📌
"you are not my peer" hell fucking yeah
We clearly have not shot enough CEOs in the back of the head.
When she closed her eye so wanted to get her whiskey
If the person she's talking to doesn't have authorization to approve anything... why are they calling her? United would rather spend *more* to treat preventable lymphedema than pay for a surgery to prevent lymphedema, and we're supposed to believe that's somehow in the shareholders' interest?
Masked secret police and anonymous private death panels. This is America. She should be able to focus her energy on helping patients, not arguing with the disgraced doctors. Doctors so deeply ashamed to be reduced to rubber stamping death warrant insurance denials that they won't give their name.
Insurance companies are often so short-sighted when it comes to this sort of thing, too, since it frequently ends up that the doctor is right and the patient ends up needing even-more-costly care than they would have had the initial preventative step been approved.
Oh my god the absolutely *angelic* patience she’s displaying. I am *fuming* just from experiencing this merely second-hand!
As someone who has lymphedema, it is *Very* vital information! If you can knock the risk from 40 down to 10 percent….that’s incredible!! And it makes me wonder if the person on the other end of the call was just Admin and is non-practicing. Definitely not her peer.
The doctors at my old hospital had a term for these guys: "charticians."
I want to know how she even got through to United healthcare. I’m a licensed professional counselor and I can’t find anyway to talk to a live person. I’ve been trying to get paid on three sessions since May. They’ve denied it twice and two other times, they said they didn’t get the claim.
They’ve given me two wrong fax numbers to send the claims to. I have to fax because they can’t seem to get the clients in put into provider express even though they told me I would only have to send one paper claim in and they would escalate it. I’ve spent a total of about five hours on the phone.
Nightmare. Just trying to do the basics of your job. I can't imagine.
In healthcare aren’t the specifics kind of the whole thing???
Oh Damn- so now the MDs are masking because they think their collegaues who are treating the patients will threaten them- what has health care come to.
It's almost like free market incentives don't work for health care.
This is America… Somebody’s gotta make a profit off of your sickness. Any other way is communism, or something.
People complain about short appointments and long waits to see a specialist. Those problems are direct results of doctors having to waste time on this nonsense instead of seeing patients. All for shareholder value.
👀
@kattenbarge.bsky.social @miawong.bsky.social @rachelgilmore.bsky.social
Our health system is so full of sludge and corruption
I worked in insurance for many years and the main business of insurance is INVESTING your premium $$. Not providing coverage. When a claim is covered, they can't invest that $$, so their goal is to deny every claim. Makes sense when you understand that.
So ICE and United Healthcare have same personnel policies?
Paging Luigi
What a slimeball coward using the ceo assassination as an excuse to be shady and not identify themselves. Are they really letting a cosmetic surgeon who doesn't appear to actually know anything the power to judge real surgeries?
Have your literal doctor advocate, for you, and still get denied...what? We are nothing more than a dollar sign to the insurance sector.
I believe America can share a collective scream after watching this. My God. As someone who has the body equivalent of a lemon automobile, this is exactly what I expected went on behind the scenes, though maybe a bit worse.
There’s this thing called socialised healthcare. It enables far more people to receive care. Properly structured it should also redeploy doctors from claims assessment to medical practice, increasing the capacity of the healthcare system.
Another professional hiding their identity whilst giving their opinion. Work for power or money and enjoy its protection.
Unreal.... I wish it was "unreal". Our healthcare system mostly sucks
Opaque "peer to peer” a health insurance company health insurance coverage denial. You have to see it to believe it. Fuqqing US health insurance is a god-damned racket. These a-holes take 1/4 of my income, but deliver shit. (1/2) 📌
Wow
When I was still on private insurance (now on Medicare) I needed a partial hysterectomy for medical reasons. My doctor went around and around with my insurance company for nearly 3 weeks trying to get approval. I didn't know for sure it would be paid for until the night before the schedule surgery.
A small suggestion: replace “a health insurance company” with “United Healthcare”. If you’re worried about legal backlash, insert “alleged” as appropriate.
How do Dr’s have time to do what they have trained forever to do🤯
United Healthcare is a criminal enterprise. This is just ridiculous.
They are not experts they are doctors for pay to deny claims!
United Healthcare
She is a good doctor fighting the bad guys. I hope everyone supports her. For me and mine only one of us has health insurance and it’s for emergency only. If we get cancer or something like that where we can’t afford the treatment that’s it we just have to live our lives till it takes us.
Hugs back but don’t worry I am made of steel and will be around for awhile. Xoxoxo
Good or I will have something to say 😠🤭🫂🫂🫂
Ehehe 😆 I know you will!
Too right 🤣🫂🫂
Unbelievable!! This is why our health care system needs to be fixed!!
Hello! Are you a substandard physician who'd like to make a large amount of cash on the side? Come to work for United helping us weed out "unnecessary care", as determined by our MBAs and CPAs!
This is nuts.
We are also seeing this in healthcare technology with undermining the hierarchy of evidence medicine is based on with rent seeking behavior.
Pfff seeing this from "socialist" Netherlands it's shocking.
Yeah, it has reached a boiling point over here. Luigi Mangione was a symptom, trumpism is another. People are sick to death of the endless inhumanity of business and our helplessness before it, and are looking everywhere for a leader—any leader or figurehead—to fix it.
I’m a breast cancer survivor, don’t have TikTok, don’t want TikTok but I did forward to my husband to follow just to increase her followers if nothing else. Hope she keeps up the good fight.
I've been in and out of UK hospitals with an underlying health condition this last six months. All excellent care with zero bills to settle thanks to the NHS. The very thought of paying a bill or dealing with an insurance company in illness or recovery is heartbreaking. America, you're terrifying
Giant insurance companies have only one goal, and that's to deny service, and to return billions to their stock holders If you are sick, dying, or need care, you can go die in the gutter, that's the @GOP #MAGA way
I knew it was problematic for we the patients, but (insert 🤐expletives here) I had no idea how obstructive they are with actual working doctors/surgeons. WTF!
Now, do a patient on workers comp.
JFC!!!!!
I hope you will not be alone in this fight; it is immense. I will donate, but I know it is never enough when these corporations decide to bring their financial clout against you. If more people show your courage, the US could again be a decent place to live (from Canada, with universal heath care)
Thank you for covering and posting this!
This is exactly what I deal with as a clinician when I deal with a denial of treatment. It takes all in my power not to pop tf off on them & if I did, it's not going to help my client. I typically have to have my client file their own grievance using the Mental Health Parity Act while I appeal it.
Again I say, health insurance serves no real purpose other than to make money for itself. It improves nothing about the process and provides no improvement in quality or efficiency of service. It’s simply an obstacle for patients that makes money for itself.
We don’t have to deal with this BS here in Canada. Thank goodness - the last thing anyone needs when they are sick.
It's not just that it fails to provide an improvement in health care: it actively conspires against patients to restrict their care. The health insurers' motto: the more we spend on ordinary people and their irritating needs the less there is available to steal.
100%
Stunning. I don't know why this isn't a well-known scandal, and I'm aware that dozens of conversations just like this one happen every day, with the associated policy holders (or victims) of insurers; all lives that all of us will someday have.
Not dozens. Thousands
that's all I can think, watching this. They're willfully murdering people. Can anyone wonder why someone would strike back??
This is how Luigis are made.
*"Claims Adjusters"
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Insurance company doctors aren't medical professionals. They just wanted a doctorate to deny coverage because they suck at being an ACTUAL doctor. Easy pay to sit on your ass and just "consult" patients to death.
I've had Medicaid-paid insurers attempt to hide the identities of doctors they hired to deny my coverage. They only fail to do so because I'm the one following up. I'm lucky if it's a doctor. It's normally an algorithm or a gynecologist they hired to deny fully unrelated, usually neurologic care.
I’ll bet the denial rate is lower for patients named Luigi.
When Aetna did this to me a month ago, I was told to email the executive response team, combined into one word, at Aetna dot com. When the third party denial firm denied my claim, the response team approved it 2 hours later.
Just putting this out there mcc.ca/credentials-...
Wow.
This happens in the health sector including dental coverage. Delta dental would not speak to me and present the bona fines of who was reviewing my claim. Just that it was denied.
Bona fides. Need edit ability, bluesky!!
Just a reminder that in no other developed country in the world would a surgeon have 2 have this convo with a for-profit health insurance company middleman that denied the patient the surgery. She would just treat her patient. And it wouldn't bankrupt the cancer patient.
I hated these calls more than any part of my practice. There are no peers on these calls.
📌 #pin
UHC should be nationalized. They claim their business is providing care, but in reality their profits come from denying care. End UHC.
So the peer doctor does eye jobs in Texas and United pays them to assist in denying procedures for cancer patients?
and soon united will have 'ai' to blame instead of humans. I'm sure.
IIRC, they have quite literally said that’s what they’re going to do.
And with Trump wanting to make sure it isn't 'woke' I guess most things will be harder to get except ED pills and boob jobs.
They already use it, knowing it has a 90% error rate for denials. www.cbsnews.com/amp/news/uni...
Everyone should AVOID MEDICARE ADVANTAGE (MA) and stay with original Medicare. This United case is a MA policy. The Republicans are trying to shift everyone into the privatized MA plans. Don't do it - the insurance companies will screw you. www.cbsnews.com/news/unitedh...
Any time someone tries to say “but the CEO was a little guy uwu with a family” I like to remind them that he personally gave presentations on how good this AI was at making money by deliberately denying healthcare. He was a mass murderer and he had a PowerPoint to brag about how good at it he was.
In the wake of his death a group of shareholders sued the company because after he was killed their rate of denials went down and thus profit suffered.
You know, Rudolf Höss, commander of concentration camp in Auschwitz had (by the wall) sweet family with kids.
Literally one of the most effective mass murderers in history. In terms of how much blame we can lay on him on a per-death basis, he's gotta be up there with the greats.
Idk if he’d be in the same league as Kissinger, but that’s also part of the point: it’s by design that we have no idea what the number is. They’re not required to report how many denials they make, much less patient outcome post denial. I also think the resistance so many feel to calling him a mass
murderer is that a huge number of people fit this description: “Has been happy about how a presentation in which they showed how profitable a decision that put profits over human lives went.” It didn’t show body count, it showed regulations evaded, oil barrels pumped, light truck sales…
wasn't this a movie with Matt Damon and Danny devito?
They didnt need AI to deny coverage; they are just using AI to fabricate the reason for denial. This is a job perfectly suited to AI.
The patient has a 40% chance of lymphedema & is herself a doctor who needs her arms to care for her own patients. Lymphedema can be permanent. The eye doctor is a monster for doing this “job.”
I think that's a generous interpretation. Sounds like they have some fellowship training in that area. Currently in "cosmetic practice" could mean they own a med spa and loosely oversee Botox injections
If a physician has this much pushback from insurance imagine how difficult it is for a layperson to appeal denials. And yeah, those “United physicians” are ashamed but still accept those bonuses for helping “reduce costs”, and increase profits, thus, they are complicit.
📌 Watch me
I would say "Unbelievable!" but, in the US health care industry, and especially coming from UHC, it's completely believable.
Unbelievable
Excellent Advocacy by this Doctor! Insurance Companies make money by DENYING care and they waste money by hiring ranks of staff people tasked with DENYING care. Wipe out private insurance! This Doctor is experiencing the blunt end of economic power. Its not about patient care. Its about money.
This is weird to me coming from the NHS. Plenty of problems over here but if you need surgery for cancer and you get the best available treatment. Free. It was so weird I thought it was fake until I looked her up. America richest country in the world and you can't even look after your own.
*can but won’t. Because “profit.”
And tax cuts for corporations that abuse us like this...and, of course, billionaires.
So... "Profit"
You don't get to be extremely rich without exploitation, extraction, and violence.
Got to have that latest and greatest war machine that'll collect dust just sitting somewhere. All guns, no butter.
Well, the Tories, Reform, and even Labour want to tear it up for a US-style system that enriches the 1% in exchange for far greater sickness and deaths in the 99%.
We will not be the richest for long.
Health insurance companies are the mafia of health care. Flat out gangsters. Criminal vampires sucking all the blood out of our health care system. There is an alternative. We simply need to organize and harness the political will to move on from this corrupt system.
Great system where the ins co experts get to decide based on profitability if you need coverage. 15 years ago I broke tib/fib Nov/Feb 2nd surgery. By end of Feb ins co said PT no longer needed wouldn't be covered. Conveniently it was after I paid 3K deductible twice in 6 months. Always about $$$
Awful. Profiteering from ill health is immoral and should be criminal.
@drianweissman.bsky.social
Preaching to the choir, I know. But if you encounter a licensed physician or a nurse who does not 110% despise EVERYTHING about the American healthcare industry (not the practice of medicine, the INDUSTRY) - Do not invite them in - Do not meet with them at night - Do not make eye contact
- Check mirror reflections regularly - Carry holy water as a precaution
"Hello, my name is Doctor Remmick, I'm a family practice physician at Northwest Community Hospital, and I'm here to tell you about the dangers of socialized medicine!"
How crazy that a surgeon should have to spend this much time just finding out if the person on the line is actually qualified.
Surely you need a system that is recognised and required.
Wow, it’s the side step and avoidance technique. Wow, insanity abounds, its why people are so frustrated with the system the way it is set up. The ones who suffer ultimately are the patients but also providers and those providing services because they have to spend countless hrs in approvals:
$10 says Mr. Unknown isn’t even a fucking doctor. 👨⚕️
And there were TWO people she was talking to who refused to ID themselves.
This is insane. We need universal health care. Health care should be a right. That call wasted her time and energy that could have been spent elsewhere
And universal health care would be a popular campaign pledge. Dems could use it to get elected... but nope, the Dems are old, corrupt and useless.
Democrats take a lot of money from private health insurance companies just like the Republicans. We’ve got to get money out of politics or this will never end.
Whoever runs in 2028, if they don't have an anti-corruption platform to fight against the abuse of money in our society, then they aren't the right candidate to have the US
$ out or it's the end of the republic.
Insurance companies managing care for Medicaid tried to pull this when I was an admin law judge The way to get them to identify actual physicians was to require approval of every service and procedure that did not have a name attached to the denial
Fuuuucking United HealthCare!
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What a nightmare all of us will be facing. The corporations own our lives now too
But socialized medicine means we won't get treatment by people who know what they're doing, right?
No, it’s because “those” people might be treated equally.
Specifically, because the elites would have to endure the indignity of "those people" being treated in the same way they are. Even if their own care is no worse (even if it's better!), they hate the idea of their "lessers" having the same (or a even similar) experience.
this is how it goes with insurance companies We have to start with a peer to peer where our doctors have to waste their time on the phone and there’s no approval from a peer and then you have to move onto an appeal and then you can move onto a secondary appeal and nine times out of 10 you get denied
Just want to make people aware that by law when we do peer to peer consult, they need to be with a peer of your level. It can’t be that you’re talking about breast cancer with your urologist, but nine times out of 10 that is what happens.
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This is the kind of scenario that some politicians want in Canada with private healthcare.
I know. The previous government in Manitoba tried HARD to move this way. They were still cutting health care. At the HEIGHT of COVID.
Ontario too.
It’s really sad how there is no fairness in government systems these days.
Thank god no one has to wait for care in the US and that everyone has access
I once made a claim on my homeowners insurance and they tried to collect from some handyman who had done a totally unrelated repair on my house. I refused to go along with it and paid the repair myself. Insurance is just a scam!
Original source: bsky.app/profile/pizz...
This is an absolutely glaring security hole. The OP is so right: how can she tell the person on the line is legit at all? They don't offer ANY means to verify anything! Imagine the levels of social engineering you could exploit to, I dunno, get your own claims written off or approved.
could just be an ai chatbot
Every day this happens. To every doctor in every state. Arguing for appropriate and medically necessary treatments - and getting denied anyway.
#📌
Good lord. To think that someone this well spoken, clearly well educated and knowledgeable in their medical field, who has evaluated a patients needs, is unable to approve critical surgery for the patient because a middleman has deemed it not necessary, is infuriating and very confusing.
Doesn't happen here in France. The doctor orders it- it gets done.
One of the many reasons I moved to France 7 years ago. The U.S. “healthcare” industry is a fucking nightmare if you become seriously ill.
Especially if you aren't on full blown Medicare with the best possible Medigap coverage. In all other cases you will be paying up to your Max Out of Pocket and fighting with your insco who want you to die quickly.
We're well aware.
Also, any serious chronic disease- cancer is one- is covered 100% by the government. They will even deliver you via private taxi to your chemo treatments.
heheheh i have to pay $100 a month so I can pay $35 a visit so I can pay only the first $3000 of a treatment so that I can get 50% off the total cost hehehe i die
But that's only if they approve it. If they don't approve it you get nothing if you still want/need it. What sadist designed this system?
Unfettered capitalism.
Invest in healthcare stock. Also tobacco. Oil...
I'm not terribly motivated by money.
That's a real problem in the US right now. If you aren't , you are screwed. I really like the European attitude. France is threatening to take away 2 public holidays to fix the budget. This will be very interesting.
Alright alright, stop rubbing it in already
Gotta respect the French people for knowing the best way to interact with their political leaders.
If we could trade our police for theirs I think we'd be a little more willing.
Indeed. We should try the guillotine here!
I refuse to do fake peer to peers. If they tell me in advance “oh this can’t affect the decision” I tell them to stop wasting my time and keep spamming appeals
Can't the surgron and patient sue if they haven't already?
Lot of good it does when the patient is dead and buried by the time the suit over their denied procedure is resolved.
Paging Dr. Luigi
Insurance companies are paying idiots as experts...good to know.
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Wow! Just wow.
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Let's get Luigi on it
Health Insurance is a man-in-the-middle hack on our healthcare.
Medicare 4 All would be a great solution. Get rid of the middle man.
if we could get the legal system out of medicine on both the sides of doctors and insurance companies this wouldn't be occurring, like they do it in "socialist" countries....
And people wonder why HC costs are so high. This is only a small amount of ridiculous red tape the medical professionals have to go through to get their pts needs met.
Galling.
that's a lot of wasted time :(
Let no one be misinformed: United Healthcare is the Bad Guy. Full Stop.
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And they wonder why the CEO was killed. America, the wealthiest nation in the world has more often than not, the worst healthcare system in the world.
Guess we need more luigi
Women surgeons are hard as nails ❤️ So much respect
Oh dear lord!!! This is ridiculous!!
If he was proud (or qualified) of what he was doing he’d give her his name.
🖤🖤🖤
I can’t help but think my doctor wouldn’t fight this hard for me…that most wouldn’t bother or have the time to do this for a customer. Most just roll over and move on, I’m sure. Good for this doctor and her patient, sad state of affairs.
These microsurgeons who perform breast reconstruction using microscopes in the operating room for up to 16 hours at a time are very tough. I wouldn't mess with them if I were united.
My wife was treated by Dr. Potter when we lived in Texas. She's amazing. If you think she must be hiding something here I can assure you she's not. She's amazing, does great work for her patients, and is 100% legit. Just saying.
Welcome to the US
And you understand Luigi. This physician has the patience of a saint.
Especially as this likely hasn't been the first patient she's had to do this for.
Oh look it's the Death Panels that the Right so strongly warned us about during the ACA debates. Except, wait, this is with private for-profit insurance? I thought death panels would only exist with government healthcare!! Color me shocked.
The Luiggi complex !
Australia, wake up, we are heading down this path with the slow dismantling of Medicare only funding (increasing gaps) and increase of private insurance power into the hospital sector.
The only reason someone would not identify themselves on this sort of call to a fellow physician is because they are deeply ashamed of what they are doing. Or, if not, they still know it is morally bankrupt and don't want anyone to know who they are. Self protection be damned.
Or, their primary source of income is gatekeeping for an insurance company. Imagine if a patient—or a physician—had the time and money to haul these health vampires into court and force them to divulge the identity of the godling who can say NO but not YES. Far fewer godlings.
... or they're not actually a certified doctor/specialist...
The call should have ended after the person on the other end refused to identify, but still wanted to influence prescription of treatment. This is a fucking clown show. The insurer can hook any person on the line and have them tell to prescribe specific treatment?
Or their license has been revoked.
This is it right here They are trained as doctors but can't work as licensed doctor So they look over claims instead, and get paid well for "protecting" the insurance company
I don't see how this isn't an automatic lawsuit, there is no verification that this isn't some rando practicing medicine without a license. If they're worried about their asses for corruption, they can find another line of work. These people need to face consequences.
Yeah in this case you do not have to give them insurance company the benefit of the doubt. I would assume offhand that, rather than a qualified, licensed doctor familiar with this disease and procedure, that they pulled in some random intern who is reading from the DenyClaim.docx call center script
I just was on the phone today with Aetna over same kind of thing their denial of a claim after peer to peer failed to get it paid. They were of no help at all even when I started to speak up for myself at the Aetna idiots they just belittled me more. #freeLuigi
Wow dude
Thank God I live in the UK. With all its faults, the NHS should never be taken for granted.
Don’t let your government take it from you. The conservatives here work with the Tories to encourage them to adopt a more far right American-style conservatism. I look at news from the UK these days and I can see our Republican Party’s sticky fingers all over it. That’s not golden syrup either.
I don't understand how the insurer can field a person to "consult" on a case where the consulting person can not be identified. How is this legal? Without ID, can't anyone recommend any treatment, then?
💪 “She said regardless of the outcome of her battle with UnitedHealth, she was determined to continue treating breast cancer patients. ‘I’m taking a hit and it hurts,’ she said. ‘But I am made of tougher stuff than this. They picked a fight with the wrong lady.’”
Absolutely ridiculous!
Why do we all collectively put up with this, nobody likes our healthcare system.
🤦🏻♂️ just one of many reasons why health should not be a profiting business
And this is why I have refused to work with United Healthcare/Optum. It is sad because as a mental health provider they were decent in pay and didn’t fight paying me to bad but I just couldn’t do business with such a corrupt company.
Have I missed something? Surgeons do years of training to surgeon. Not effing talk to faceless clowns at insurance companies
This is just maddening and a strong case for universal publicly funded healthcare.
I knew a young woman who had lymph nodes removed (more than 30 yrs ago) and ended up with lymphodema in her arm. It looked terribly uncomfortable - one arm was huge and swollen. The point is, itʻs not a cosmetic issue.
Wasting a doctor's precious time. Unreal. She could be doing her documentation, but now has to stay late to do it and take time away from her family
That too!
Her professional demeanor is a work of art. I would’ve sworn.
I was always afraid that if I pushed back too hard they would deny care.
Not nowadays, they’re recording everything we say and do and they’re coming after us when all we are doing is fighting for our patients
I would have started crying when I got off the phone.
So can we now finally settle the debate that privatized healthcare, without very strict regulations does not work in the benefit of patients?
Strictly regulating private healthcare sounds like federal coverage with horrible extra steps, more uncovered people, and a higher price tag to funnel money to shareholders and executives.
The netherlands have this system, where the government decides what is obligated included AND insurers cannot decline customers. It works, not perfect, but better than the above. Alternative is public funded healthcare. Not perfect as well, but better as well.
Or countries.
100 percent
UHC denies pretty much everything. I’ve had breast cancer & have a high risk of recurrence. They’ve denied mammos when I’ve had mystery lumps & my annual breast MRI. Also pre approved procedures after I’ve had them. I feel like I’m in an abusive relationship w my health insurance.
Because you are Rhoda, I'm sincerely sickened at this behavior from United Healthcare...
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This is just enraging. There is no reason that we can’t have a fair and less expensive health care system except, of course, because the one we have makes lots of cold hard cash for share holders. This is unacceptable and ultimately not sustainable.
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I can’t adequately express my contempt for these so-called “peers” that exist solely to exploit the suffering of patients. Also, UHC is a cancer on our society.
The only boundaries of my rage reside in my impotence to do anything at all
Excellent way to describe it. I will be quoting you.
listen to the fake doctors on the phone - it would seem that anyone can do anything if we want it bad enough
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My employer has decided, to save money, to change from BCBS to UHC and this exactly what we fear. For those of us with higher chances of developing cancers, this is a nightmare and feels like foreshadowing. @fantasyyeti.bsky.social
She did a fabulous job in trying to reach resolution and navigating obfuscation
This is why insurance needs to be fucking nuked and all of the fucking businesses of them with it. As a former biller who had to fight this shit for authorization hell. (God i do not miss that bullshit)
They hosed us for $5K. I guess we should be happy that it only came down to money instead of lifesaving treatment.
I used to work for a PCP and somehow found myself the unfortunate admin of all prior authorizations for the office. The amount of time that I spent arguing with insurance companies and the amount of time that employees of those companies spent with me was mind-boggling. I swear it'd be cheaper +
for them to just pay for shit.
Why do people keep bringing this song up in this context? This song isn't about healthcare, it's about an angry green plumber. How is "Player 2 Has Joined The Game" related to any of this? I don't see the connection. 🤔 music.youtube.com/watch?v=vTgT...
Huh weird why am I hearing the Mario Bros theme song
eee ceg G
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I don’t do TikTok, but I do follow her on Facebook.
There is a special place in hell for ANY MD who works for an insurance company to actively deny services.
Apparently quite a few have lost their license to practice so there’s that www.propublica.org/article/malp...
This is why I document insurance denials in the patients' progress notes. Because someday a patient's family will sue an insurance company after a bad outcome, and I want it all well documented for them when they do. It's horrible that it comes to this. It's not why we practice medicine.
I worked in a primary care and the thing they drilled into my head was notes notes notes. Note everything to back yourself up later.
“Trust me, bro”.
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This makes me cry. Not only for the patients, but the trained, dedicated medical workers who have to put up with this absolute bullshit.
Parasites, the lot of them. Imagine this single conversation, devouring the time and brainpower and burnout capacity of a surgeon who cares for their patients, writ large across healthcare country wide. What a goddamn waste.
It’s acting exactly as designed. It’s designed to be exhausting It’s designed to be cumbersome It’s designed to make you give up It’s designed for you to fail and insurance companies to profit.
Ugh. This is not how healthcare insurance personnel should perform their duties. It's unconscionable.
No heath care company should be for "profit". How do they get bonuses? By saving $$$, how do they "save money", you guessed it. A company should not be able over rule your doctors medical advice and orders.
INSANE
Must see.
The problem is billionaires do not fear the rest of us
This is what the Nazis do.
What an incredible advocate. You’d be lucky to have her as a doctor.
Worked in AutoIns. RECOGNIZE THIS. This would be: ‘THE PHONE CALL MAZE’. You WILL NOT get thru The Maze Because Ins Co’s DON’T WANT YOU to get thru The Maze. This regards CRITICAL HEALTHCARE PROCEEDERS THEY DON’T WANT you to HAVE. American Healthcare IS Hell.
I know it's been said before but healthcare in this country is a Kafka novel.
Thank you for sharing. The horror. I'm speechless.
This all sounds very efficient. I’m sure everyone is better off because of this well oiled machinery 🫠
She's great. They're anonymous hacks whoring for United Health.
How do professional women maintain their composure under such indignity (rhetorical)? My rage meter was rising just watching that and I wanted to smash something when the call ended. Also, how do I get a doctor like that?
Thank you Dr. Potter, for vigorously advocating for your patients. And since you can’t say it, I will - what the FUCK?!?!
My surgery was denied the day before it was scheduled due to the insurance company wanting me to do 6 weeks of PT first. For a labral tear. I cannot walk well. PT will not heal a labral tear.
We see so many patients with a labral tear because they have to do pt first and they all have surgery and come back feeling better.
Good to know. Thanks.
Hope you can get your surgery soon. That one has a quick recovery and high rate of success as well so there’s no reason it shouldn’t be covered.
Mine also denied—the morning of my scheduled surgery (a different medical issue). Did everything they asked me to do, PT, specialists, etc., and the morning of the procedure they denied the surgery as unnecessary. Three years on, chronic pain, worsening over time.
I am so sorry.
Ugh! It’s terrible. I was on edge for months before my surgery, worried about it being cancelled. This system sucks! In my 30s and 40s, they denied me a treatment for the endometriosis that caused me severe pain 1/3 to half of my time. Their excuse was it was birth control. My doc fought & lost.
Oh no! This system is new, this did not happen 10 years and more ago.
The system? Insurance companies have been denying treatment to patients in the United States for at least 20 years.
Husband had to have 6 weeks of PT before he could get an MRI...because, hey, just schedule PT without knowing what's wrong. And yes, it made things worse.
I heard about that being done as well. It makes NO sense. How can you have PT with no confirmed diagnosis?
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Fuck United!!!
I guess there are reasons why Canada, for example, has a life expectancy three years higher than the US despite spending half as much per person on healthcare.
Stares back in “death panels”
UHC is in the insurance payment for treatment denial business.
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“First do no harm” is this really what the medical profession has devolved into, where is the concern for the patient rather than hiding your identity and qualifications?
Insurance companies never pledged that oath… sadly. But this is why we need universal healthcare, now
Omg! This is so wrong!! I’m a retired OB/GYN nurse. I remember the MD I worked with called an insurance co. who had denied insulin coverage for a patient who had gestational diabetes!!! I had called them first & got nowhere! The patient was eventually covered. But this should not be the norm!!
That’s nuts. Meanwhile, the insurance was likely funneling “donations” to the “pro-life” party.
Holy shit
We’ve medically determined that your patient is no longer a profit center so we are therefore denying the procedure. America the beautiful.
But an insurance based system will be more ‘efficient’ than the NHS? It’s wild how much time this doc spends persuading another person of the necessity of a treatment.
Yeah. Canadian doctors don't have to waste time like this*. No wonder the US spends so much more than everyone else, with worse outcomes. 🙄 *They do complain about administration and wait times.
"Hi I want to talk to you about axillary dissection... "Oh no. Sounds expensive. "My patient is very ill.. "So you're saying there's not much point wasting any money on her? "But what is your medical opinion? "Neck bone connected to the head bone. That'll be $10,000 for the consult. Thank you.
JFC!! As someone who has spent thousands of hours as a patient dealing with my insurance company this really pisses me off. UHC needs to be put out of business and all of its stakeholder bankrupted! These mf’ers literally kill people because the decision makers are INCOMPETENT!!
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The second thing you need to do after signing up with United Healthcare is make out your will
Omfg. We are so screwed. 🤬
It’s fucking ridiculous that in a country as wealthy as America that you don’t have free health care. Thank god I’m British.
Don't count your blessings for too much longer the way mr Streeting is going about things.
Very good point. Let’s also hope reform don’t win the next election
And naked cowardice is now the norm in American society! Especially among Conservative White men!!
Why does UHC label themselves insurance if they actively work against insuring. If UHC doesn't care for insuring, they should go do something else. Unbelievable.
But everyone was worried about “death panels” run by unelected bureaucrats, so instead we have unelected, unknown, faceless, incentivized, oligarchs basically running a death 2 on 1 phone chat
We’re all going to die.
I watched those two vids, friggin' unbelievable 🙄
Thanks for posting this. 📌
Charlie Baker is the head of the United Health monster. Until he's exposed, United Healthcare will continue to cause preventable harm, suffering and death of its captive subscribers.
I saw another doctor on TikTok last month saying United denied him a peer-to-peer call after denying to cover a patient's MRI pre brain tumor surgery. These insurance companies are irredeemable.