A breast cancer surgeon had to “scrub out mid-surgery” to call a UnitedHealthcare representative because the insurance giant questioned whether the procedure she was in the middle of performing was really necessary.
Dr. Elisabeth Potter posted her story to Instagram this week, and the post has gotten more than 221,000 likes.
Still wearing her scrub cap, Dr. Potter began her video saying, “It’s 2025, and navigating insurance has somehow just gotten worse.”
Just make it not up to the insurance company. If the healthcare provider believes it’s necessary care, then the insurance company pays. Full stop. They get no say in the matter, and denial is not an option.
“But health insurance would become unprofitable!”, they’ll cry? Good. Necessity shouldn’t be exploited.
This would incentivize abuse of the system by quacks and malicious profiteers trying to overbill, but Medicare/Medicaid seem to manage that problem just fine through fraud laws/policies.
If the insurance company believes it’s actually unnecessary care, they can take up a complaint with the medical board and only get to claw back money if an independent panel of doctors in the same specialty agrees that it was unnecessary or unethical. A bonus from this is that insurance companies would have incentive to make sure doctors are well-trained to know what testing/treatment is actually warranted. Btw, “necessary” doesn’t only get to mean you get the minimum required to keep you from dying today; quality of life and long-term prognosis must be required considerations.
If the insurance company believes it’s fraud, they can take it up with law enforcement too.
Another thing that could help would be to make the medical/nursing/etc boards better equipped for investigation/enforcement of ethics complaints and to make disciplinary records follow those who would move to another state to get a new license, and also make those disciplinary records readily accessible by the public on a centralized national database. Bad actors will not be able to continue being bad actors if they lose their license, can’t get a new one, or wind up in jail.
Even better, let’s just have a national healthcare system.
Healthcare providers charge people without insurance the cost of an MRI machine for using the MRI machine tho. I wouldn’t rely on their benevolence.
Sure, but in this theoretical ideal world we wouldn’t have the problem of being without insurance either. That is, if we had universal Medicare instead of a for-profit insurance industry, then no one would be without insurance. The Centers for Medicare and Medicaid services dictates what they’ll pay if you want to get reimbursement from them at all (unless you’re a pharmaceutical company, for some reason, then you can charge whatever you want), and the hospitals where MRI/CT/etc. machines are housed would all quickly crumble without any Medicare/Medicaid reimbursements (and actually would be better off financially if half their ER patients were not uninsured).
And if we can’t rely on their benevolence, then the licensing board or law enforcement would theoretically address any problems. Ideally, anyway.