Health
Surgeon shares story of insurance provider calling during patient's surgery
A surgeon in Austin, Texas, was in the middle of surgery when she was notified of a phone call from the patient’s insurance provider.
Dr. Elisabeth Potter is a board-certified plastic surgeon who specializes in reconstruction for women who have had breast cancer. Last year alone, she did about 520 surgeries for cancer patients.
She recently shared a video of herself talking about the experience.
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“I just performed two bilateral DIEP flap surgeries and two bilateral tissue expander surgeries,” she said in the now-viral video.
(In DIEP flap surgery reconstruction, skin, fat and blood vessels from the patient’s abdominal area are used to rebuild breasts.)
Dr. Elisabeth Potter, a Texas surgeon, recently shared a video of herself talking about a phone call that came in from an insurance company during a patient’s surgery. (Dr. Elisabeth Potter; @drelisabethpotter)
During one of the DIEP cases, while the patient was asleep on the operating table, the doctor was interrupted by a nurse supervisor informing her that a call had come in from UnitedHealthcare, the patient’s insurance company, Potter said.
The nurse who took the call said that Potter was in surgery and not available.
“And they said, I need to get her a message because we need to talk to her about this patient,” Potter told Fox News Digital. “So they wrote a note and brought it into the operating room and I took a picture of it, because I’m like, I can’t believe this is happening.”
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The note indicated the name and number of the person to call at UnitedHealthcare, along with the patient’s name and Dr. Potter’s name. (The note did not state that the caller had requested an immediate response.)
“The nurse at the front desk of the OR who took the call and wrote this note said that the person on the phone first asked for the patient and then for me,” Potter told Fox News Digital.
“I made that judgment call and I stand by that — I think it was the right thing to do for the patient.”
“He was told I was scrubbed in[to the] OR and he asked the nurse that I be contacted in OR and given the message.”
Added Potter, “The nurse manager said she had never in her career received a call like that before. She thought it must be important and brought the message to the OR.”
Dr. Elisabeth Potter, a surgeon in Austin, Texas, was in the middle of surgery when she was notified of a phone call from the patient’s insurance provider. (Dr. Elisabeth Potter; @drelisabethpotter)
It was odd, Potter said, that the insurance company had called the front desk of the hospital, where she is not an employee.
“They didn’t call my office. They didn’t call my cell phone. They didn’t send me an email. This wasn’t the billing department of the hospital.”
Afraid that the insurance company might deny the patient’s service, Potter made the decision to scrub out mid-surgery to return the call to United.
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The surgeon stated to Fox News Digital that UnitedHealthcare did not require her to leave the operating room or threaten to deny coverage.
The patient was safe with another surgeon and the anesthesia team, who were finishing up the procedure.
Dr. Elisabeth Potter is a board-certified plastic surgeon in Texas who specializes in breast reconstruction for women who have had breast cancer. (Dr. Elisabeth Potter)
Potter was “scared” that the patient would wake up and find out that the insurance company said they didn’t have the information they needed and would deny the claim, she said.
“I’ve seen it before, when people get stuck with bills that are $80,000 or $100,000,” she said to Fox News Digital. “And so I said to my partners, ‘I’m going to make this call real quick.’” (See her video here.)
“Dealing with insurance is a really important part of taking care of patients affected by breast cancer, because the diagnosis is financially devastating.”
“If it had been at a critical moment during the surgery, I wouldn’t have,” Potter clarified. “But I made that judgment call and I stand by that — I think it was the right thing to do for the patient.”
On the phone, the insurance company stated that they needed to know the patient’s diagnosis and the justification for the inpatient stay, something Potter had already communicated, she said.
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“And I was like, wait a minute, we got authorization for the surgery. We submitted all of our clinical documentation. We’ve done all the paperwork, the phone calls, all the stuff. You have her diagnosis codes, you have all of it,” she went on.
“And they said, ‘Actually, I don’t, another department has that, but I need this right now,’” Potter said. “There was a sense of entitlement to my time and to the information in that moment,” the surgeon added.
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Potter also noted that the person on the line didn’t have access to the patient’s full medical information, despite the procedure already being pre-approved.
“I’m not sure that person even understood that they had an impact on those patients I was operating on,” Potter told Fox News Digital. “They were just thinking about money and numbers and were not understanding at all.”
Potter was “scared” that the patient would wake up and find out that the insurance company said they didn’t have the information they needed and would deny the claim, the surgeon told Fox News Digital. (iStock)
“It’s beyond frustrating and, frankly, unacceptable,” she told Fox News Digital. “Patients and providers deserve better than this. We should be focused on care, not bureaucracy.”
Potter noted that she has always been “devoted” to providing care in-network through insurance.
“Dealing with insurance is a really important part of taking care of patients affected by breast cancer, because the diagnosis is financially devastating,” she told Fox News Digital.
“I’ve found that I really have to engage directly and think about insurance and whether they’re covering treatments and what my patients are experiencing.”
Potter emphasized that she doesn’t think insurance is “evil,” noting that there are some “really good things” about businesses that take care of people.
It was odd, the surgeon felt, that the insurance company called the front desk of the hospital, where she was not an employee. (iStock)
“But this has developed into something that no longer is devoted to patient care. This is just a machine that’s running and making money, and they don’t care about me as a provider,” she said.
Many physicians have given up and refuse to deal with insurance companies, opting to stay out of network and let the patient pay upfront and deal with getting reimbursed, Potter noted.
“Patients and providers deserve better than this.”
“I’ve gone to Washington, D.C., I have fought to protect access to [breast] reconstruction,” she said. “I have testified in the state legislature about these issues.”
She added, “It’s just getting undoable. And this moment, this week, was like, we’ve crossed a line — they’re actually in the operating room.”
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Fox News Digital contacted UnitedHealthcare for comment. The company sent the following statement.
“There are no insurance-related circumstances that would require a physician to step out of surgery and it would create potential safety risks if they were to do so.”
It went on, “We did not ask nor would ever expect a physician to interrupt patient care to answer a call and we will be following up with the provider and hospital to understand why these unorthodox actions were taken.”
Separately, the head of UnitedHealthcare group said on Thursday that the company remains “focused on making high-quality, affordable health care more available while making the health system easier to navigate for patients and providers.” (iStock)
Separately, the head of UnitedHealthcare group said on Thursday that the company is confident it will be able to grow its business in fiscal year 2025.
“The people of UnitedHealthcare remain focused on making high-quality, affordable health care more available to more people while making the health system easier to navigate for patients and providers, positioning us well for growth in 2025,” CEO Andrew Witty said in the company’s earnings report on Thursday.
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His optimism comes shortly after the head of its insurance unit was gunned down in New York City, inciting a heated conversation about the role of the health insurance industry in the United States.
Fox News Digital’s Daniella Genovese contributed reporting.
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A new injectable therapy is showing positive results in reducing melanoma throughout a five-year period.
The personalized mRNA cancer therapy, called intismeran autogene, combined with the cancer immunotherapy drug KEYTRUDA (pembrolizumab), is a collaboration between Merck and Moderna.
The results from the phase 2b KEYNOTE-942 study were presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago on May 27.
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After about a five-year follow-up, the combo drug was found to reduce the risk of melanoma recurrence or death by 49% compared to pembrolizumab alone.
The researchers analyzed data from 157 patients with high-risk stage 3 and 4 melanoma whose cancer had been removed via surgery. The participants were split into two groups — one received the combo therapy and the other only received pembrolizumab, according to a press release.
The therapy was found to reduce the risk of melanoma recurrence or death by 49% compared to pembrolizumab alone after a five-year follow-up. (iStock)
The findings revealed that the combination group saw benefits that were “sustained and durable over time.”
Intismeran autogene is designed using mutations identified in a patient’s own tumor, with the intention of teaching the immune system what the cancer looks like so that it can recognize and attack it.
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According to the researchers, intismeran is “well-tolerated” with a “manageable” safety profile.
The most commonly cited side effects of the personalized mRNA vaccine plus KEYTRUDA were fatigue, injection-site pain, chills, fever and headache. The researchers reported no new long-term safety concerns and no severe vaccine-related adverse events.
The combination therapy is currently being evaluated in a phase 3 study — the final confirmation stage.
Patients with late-stage melanoma have a “significant risk” of cancer recurrence, according to an expert. (iStock)
In a Merck press release from January, Kyle Holen, MD, Moderna’s senior vice president and head of development, oncology and therapeutics, noted that this data highlights the “potential of a prolonged benefit … in patients with resected high-risk melanoma.”
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“We continue to invest in our platform in oncology because of encouraging outcomes like these, which illustrate mRNA’s potential in cancer care,” he said.
Dr. Marjorie Green, senior vice president and head of oncology, global clinical development at Merck Research Laboratories, also commented that for many patients with stage 3 or 4 melanoma, there is a “significant risk of recurrence following surgery.”
Researchers confirmed that the combination therapy is currently being evaluated in a phase 3 study. (iStock)
“As such, demonstrating the longer-term potential of intismeran autogene and KEYTRUDA to reduce the risk of recurrence for certain patients with melanoma is a meaningful milestone,” she said.
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The company cited encouraging five-year follow-up data and pointed to upcoming late-stage INTerpath trial results with Moderna in several hard-to-treat cancers.
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An accidental lab discovery has opened the door to entirely new ways of preventing the flu.
While investigating how influenza replicates, researchers discovered that different flu strains use completely different strategies to infiltrate human cells, SWNS reported.
By targeting the specific molecules the viruses rely on, scientists found that they could block them from entering new cells and halt their replication altogether.
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Researchers say these “fundamental insights” into seasonal influenza highlight a clear path toward developing better preventive medications.
“The hope is that fundamental, curiosity-based research like this helps to pave the way for novel strategies to treat and prevent influenza infections,” principal investigator Dr. Emily Bruce, from the University of Vermont’s Larner College of Medicine, said in the SWNS report.
While investigating how influenza replicates, researchers discovered that different flu strains use completely different strategies to infiltrate human cells. (iStock)
While several flu strains cause illness, H1N1 and H3N2 influenza A viruses are the most common. However, current flu tests cannot differentiate between them, and clinical treatments are identical for both.
Although vaccines and antivirals are available, Bruce noted a “dire” need for better medications to stop the virus from spreading cell to xxcell.
“You don’t get sick when a virus is in one cell,” he noted. “You get sick because a virus replicates itself and goes into many more cells.”
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The study, which was published in The Journal of Virology, originally aimed to map how viral RNA segments are transported within cells to create new viral particles.
The team used H1N1 and H3N2 viruses isolated from the nasal passages of positive patients in 2022.
Clinical treatments remain identical for both primary strains of the flu virus. (iStock)
During the investigation, the team unexpectedly stumbled upon a cellular pathway that blocked the virus from entering lung cells, SWNS reported.
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The data revealed that when a specific human protein called Rab11B was depleted, H3N2 viruses failed to enter human lung cells. H1N1 viruses were completely unaffected.
Using reverse genetics, the team mapped this defect and uncovered a brand-new, H3N2-specific role for Rab11B during viral entry.
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This discovery challenged the scientific assumption that all flu viruses enter cells the same way.
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“Viruses are like pirates from different countries hijacking someone’s ship,” Bruce said. “Different viruses, like different types of pirates, use different methods to get onboard.”
This discovery challenged the scientific assumption that all flu viruses enter cells the same way. (iStock)
“We had previously thought that all flu viruses used the same way to get into a cell, but we discovered that this is not true,” she went on. “H1N1 and H3N2 need different proteins to get in, and if you get rid of the right protein, a specific virus can’t get in.”
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While these findings identify a critical cellular pathway for viral entry, the study was conducted using isolated cells, the researchers acknowledged.
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Further research is needed to determine whether blocking the protein is safe and effective within a live, complex human respiratory system.
Bruce and the team hope to conduct further research to determine whether this Rab11B-dependency is a fundamental property of H3N2, or if it’s a trait unique to currently circulating flu strains.
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Eating processed meat like ham, sausage and bacon may be linked to a higher risk of certain types of cancer, according to new research.
While health organizations have already confirmed that processed meat can contribute to colon cancer, this study looked closer at cancers in the upper digestive tract, where the link has historically been less clear.
To understand these connections, researchers from the European Prospective Investigation into Cancer and Nutrition (EPIC), one of the world’s largest long-term nutrition and cancer cohorts, tracked the health and diets of 450,112 people across Europe for an average of 14 years.
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The study group included 131,426 men and 318,686 women, according to the study’s press release.
During the follow-up period, 876 people developed stomach cancer and 215 people developed esophageal adenocarcinoma, which is cancer of the tube connecting the mouth to the stomach.
For female participants, eating both processed meat and white meat was linked to an increased risk of developing the disease. (iStock)
Researchers tracked where the stomach cancers grew, separating them into the upper part of the stomach near the throat and the lower part of the stomach.
The researchers also sorted the tumors into two categories based on how the cancer cells appeared under a microscope: intestinal, which forms more organized structures, and diffuse, in which the cells are more scattered throughout the tissue.
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After adjusting for other lifestyle factors, the researchers found that for every extra 30 grams of processed meat a person ate per day, their overall risk of stomach cancer went up by 9%. Eating that same extra 30 grams a day was also linked to a 13% higher risk of esophageal adenocarcinoma.
A standard single slice of regular deli-sliced ham or lunch meat averages around 28 grams, according to USDA data and nutritional tracking databases.
An extra 20 grams of white meat, such as chicken and turkey, was linked to a 12% higher risk of cancer in the main body of the stomach. (iStock)
An extra 20 grams of white meat, such as chicken or turkey, was linked to a 12% higher risk of cancer in the main body of the stomach, the researchers noted.
The study also revealed differences between men and women. For male participants, only processed meat showed a clear, statistically significant link to a higher risk of stomach cancer. For female participants, however, eating both processed meat and white meat was linked to an increased risk.
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These findings align with global health benchmarks, particularly those established by the World Health Organization’s International Agency for Research on Cancer.
The agency has long classified processed meat as a known human carcinogen, primarily due to its strong, well-documented links to colorectal cancer.
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However, health organizations have also consistently pointed to a potential, yet less definitive, relationship between these meats and cancers of the stomach.
Eating 30 grams of processed meat a day, or the equivalent to one slice of ham, was linked to a 13% higher risk of esophageal adenocarcinoma. (iStock)
Further scientific investigation is needed to confirm the findings and to account for other underlying risk factors, such as certain stomach infections, which could interact with dietary habits.
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A key limitation of the study is its reliance on self-reported diets, which can sometimes lead to inaccuracies in how participants recall their meat consumption over time, the researchers noted.
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The findings were published in the International Journal of Cancer.
Fox News Digital reached out to the researchers requesting comment.
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