Surgeon Leaves OR for Insurance Call. Doctors, Social Media & Ethics. #448 Part 3

Let us know what you like , what you don't like about the show and , ultimately , let us know who's winning these arguments , because I need to know that I'm beating Rene in these debates . Run the tape , all right , guys . So let's transition into this discussion on United Healthcare . We're talking about Dr Elizabeth S Potter .

So if you watch it on YouTube , you can see the side screen right here . This is her after her third post about this . But basically , if you guys have been following , in essence Dr Potter was operating on a patient . She got a call from an administrator or someone came to the operating room . She was going to operate on a patient .

She got a call from an administrator or someone came to the operating room . She was going to operate on a patient . I think it was some type of either elective procedure , but most likely it was an elective procedure . Patient is asleep . Someone knocks on the door and says that hey , the insurance company for this patient is calling you . You need to pick up .

She goes , leaves the room while the patient is asleep . She says she left it with another surgeon and basically started being asked questions or further questions about this person's surgery and in essence they're trying to get more information to see if they're going to cover their stay .

So I scrubbed out of my case and I called United Healthcare and the gentleman said he needed some information about her , wanted to know her diagnosis and whether her inpatient stay should be justified . And I was like , do you understand that she's asleep right now and she has breast cancer ?

And the gentleman said , actually , I don't , that's a different department that would know that information . And I was like , well , she does need to stay overnight tonight and you have all the information with you because I got approval for this surgery and I need to go back and be with my patient now .

But yeah , it's out of control , insurance is out of control . I have no other words .

Afterwards , after two or three more social media posts , we find out now that United Healthcare is like yo , all this stuff that you put on social media that's for the birds and it's wrong , it's incorrect , you need to take it down immediately . And they are threatening some type of legal issue .

So she's saying I ain't going to be scared , I ain't scared , I'm going to keep posting . And I guess they have . The insurance company has rejected the claim for this patient to be inpatient . Yeah , so that's where we're at right now . So I wanted to talk about this because you know this is really interesting , right , like .

There's this fight that doctors have with insurance companies and then there's what patients and the public sees as like we are in cahoots with the insurance companies , but they have no idea that .

A couple of things that I'm interested in this that are very interesting , that I know you have some questions about , but some of the things that I have a question about is . I'm trying to figure this out Because there's something , guys , that's called inpatient status and then there's something that's called observation status . Who was injured ?

They got a bunch of broken ribs , they need to come into the hospital . Usually the next day I get a phone call from somebody in a hospital saying hey , does this patient need to be inpatient status or does this patient need to be observation status ?

And some of y'all may be like , well , this doesn't make sense , the patient is already inpatient , the patient is already in-house . No , no , no . What you guys need to understand is that two types of statuses for patients when they're in the hospital they're observation and they're inpatient . Inpatient usually incurs a higher fee , right ?

So the hospital will charge the insurance company a higher fee for that patient to be what's called inpatient , and then there's a lower fee if the patient is observation , right .

So if someone comes in with rib fractures and maybe they just get pain medicine overnight , you may be thinking , well , this is an inpatient , no , this is an observation , but they're still in the hospital . So you know , I'm trying to understand . Was this really about someone ? Because it looks like the patient needs to be kept overnight .

And the question is , is this a fight about the patient being inpatient status or is this a fight about the patient being observation status ? That's one question that I have right .

Um , I know you have some questions , but the other thing that I was concerned about is so for me , once a patient is intubated , right Like there's like a mindset thing , it's almost like it's like sports , it's like my mind locks in right and I can't see myself leaving an operating room to go and handle like a phone call like this , whether or not this is a

surgeon there , because in my mind there's no other emergency . There can't be an emergency with an insurance company . I can't see that happening . The patient is under anesthesia . This stuff is affecting the heart . Anesthesia affects the liver . The patient gets cold .

There's a lot of different things and I understand that the patient is and I understand that there's another doctor in the OR . The question is is who's the lead surgeon ? If you leave the OR , does that surgeon start the case ? So there's a lot of questions I got here . Dr Renee , do you want to chime in Because I know you had some questions yourself also ?

Like I am not scrubbing out of my case to go and talk with an insurance company person . Like are you kidding me ? I got my patient on the table . Like no , how did you even get this number ?

They called for a clarification on , I think there was an order that Dr Potter put in that they thought you can change the order later , but that's my thing is that we change orders all the time and guess what ?

You ever see an observation patient and be like you know what ? I'm not going to do that . I'm not going to examine the patient's belly today because their observation , oh , they're inpatient . Oh , let me bring out my stethoscope . So you have questions about her what do you call it ?

Don't sit there taking an MCAT back to back to back to back to back . When you didn't do well the first time , you take it the next month , and then you take it the next month , and then you take it the next month . Because guess what ? What that shows me is that you have bad judgment .

Judgment is based on the decisions that you make , and if you're making bad decisions , there is not a medical school in the world that can help you to not make bad decisions , because that's always a judgment call . That's you taking stimulus from the outside world and deciding what to do with that information . And for me , this whole thing reeks of bad judgment .

The fact that she went and took the phone call , bad judgment , the fact that she came to social media with a patient's like not fully identifiable information , but enough so that the patient knows I know you talking about me , okay , at the time that this thing was going on , and she didn't even make it so vague so that the patient didn't know that it was

about him or her . Like , what are we doing ? Okay , I see what you're saying .

I had a similar situation , but I don't know because she's been in practice so long . She's been in practice 15 years , so I can't really even tell if this is about me , right ? So for me , I'm just like for you to put something out that's so specific and so public that the patient knows who you're talking about .

The patient's family probably knows who you're talking about , and you're doing this in real time is very , very I mean , it's giving , as the kids say , it's giving questionable judgment . It's just . For me it's wrong .

Like me and you we're like close to we are gen x , um , so we real conservative with what we put on social media , they're not like this is what they do . They share content over everything .

Um , I do think there's a lesson here , because I think some people will say , well , yeah , it may not be perfect , but the message is right and the ends justifying the means Right . And that's the part where I'm like I don't know Right , because there's something changing .

You've taken up a fight to the court of public opinion , but you can't even reveal all of the facts , to even say whether or not this is true . So in a way it's like well , is she right ? Did she get this right , or is she making up stuff so she can look like the hero ? Is the insurance company just being a bunch of jerks ? Like what's going on ?

But there's no way for you to know . There's no way for you to know well , I just found a post .

I do think that doctors should be having a final say on what's going on , but I also understand that sometimes doctors don't necessarily , they're not necessarily trained on the cost of everything . So the question is should you know , should doctors be completely out of the decision-making as to you know what's the final , how the care is being handled for a patient ?

Right now ? We are right . Right now we are right Because you know we have a say , but we have a very minor say , right . So we decide to do something .

If we decide to start an antibiotic , if we decide to admit something , if we decide to whatever we decide to do , somebody or some company that's not clinical in nature has the final say on if they're going to pay for that . And , um , affects the patient , patient and it also affects us also . And then it affects the hospital . How to ?

The hospital responds to us and that's a problem . So , um , very interested if anybody knows any information about this , any more information , reach out to us . I might actually try to reach out to dr potter and find out , yo like she's not gonna talk to you because she's .

Not in the least , the least , I think , from the beginning , from taking that phone call and then revealing that she even like I don't even know how you tell the public I left the OR to take Hold on one second hold on one second .

There's somebody else , there's another , you know , maybe an anesthesiologist , a CRNA or somebody right , that's fine . But the fact that you would think that it's even okay to leave the operating room for something like a phone call that can be taken up after you leave the OR , like what was the point ?

Because she didn't know right , she didn't know what the phone call was going to be , she just knew insurance company was on the phone . So it's like this new insurance company was on the phone . So it's like what could they possibly be calling for ? When I have this patient , right , I've left the OR before not to take a phone call .

I've left the OR before to talk to a patient's family , right , I might have a patient's family member , you know , I tell the nurse can you go call the husband , for example , can you go call the husband ?

I tell the nurse can you go call the husband , for example , can you go call the husband and you know I want to speak to him about what's going on in the , in the OR , because there's an emergency that we didn't anticipate and I need him to know what's going on because it's going to be a longer time and I don't want him worrying .

Right , I've done that before where the ? Literally I go right outside the OR , I'm still scrubbed in . I go right outside the OR and I say , hey , this is what's going on X , y and Z , blah , blah , blah , blah , blah .

I'll get back to you , go back into the room and continue operating , right , like that has happened before , right , but you don't leave for a phone call . That is so just arbitrary .

Is this the wrong messenger ? Right message ? Like , I'm very interested in what you guys got to say , cause this is something that I want to take a look at and see , because I think I'm conflicted about this . I don't have an answer . Usually , I'm pretty like I feel like Would you leave the OR . No , I don't leave the OR for any reason .

No , I don't leave the OR for any of these things because , like , once the patient is asleep , my mind is ready , right , like I'm ready to go right .

So , like , even in trauma , once you know I'm going to the OR , I already call my backup and I say , hey , listen , I'm in the OR with someone , even if a trauma alert gets called , right , my pager goes off . I'm like I'm not coming downstairs because my backup is supposed to come in .

So I'm like , for me that's like the equivalent of , you know , shooting your jumpers before you're getting ready to play ball or whatever it may be , a pilot doing whatever they need to do .

I'm locked in and I'm ready to go and I'm not coming out , particularly if it has something to do with like it's not clinically related like anything , paperwork , insurance , any , uh , that stuff . I'll take care of that , even the next day . I'll take care of that the next day , yeah , yeah , but I'll be honest with you .

Like it's , I'll be honest , like the mid 99 of what I do is inpatient , emergent , non-elective type stuff . So I don't have to go through what you guys , or even what dr potter has to go through . I'm just keeping it real , but even if it was , I'd just be like , yeah , I have to answer that another time , like we moving forward .

The flight has taken off .

Because that's essentially what she's doing , right , she's putting her livelihood on the line for this case . That's a good question . That is a good question . Is there ever a case that's worth putting your livelihood on the line for ?

She didn't say you know the patient's name , age , you know whatever phone number where the patient lives , anything like that . But the question becomes is the patient still identifiable based on what she has said ?

I'm not saying that I have the answer to that , but I think that they're thinking about this right now , and if you guys don't think they're not thinking about this , they're thinking they're like is it worth it to have you on staff ? Is that going to ? Is all of a sudden , like you pushing this fight ?

Are we going to get more patients who are like , yeah , I want to work with that doctor , or is it going to think about this ? They're going to , right , that's one thing that you got to think about also , yeah , and I think that's a really good question of yo , like what was it ?

about that last question . Forget all the questions that I had before . Write us and let us know we get all the questions . Is there something that you would be like , nah , like in the the , what is it ? In what movie was that that I love ? Menace to Society .

Is there a scene where you're like , nah , I ain't getting out this car even though you're about to get carjacked ? Is there a scene , is there an opportunity , is there a clinical situation where you'd be like , nah , I'm standing on principle and if this means career jeopardy , then this is it Very . Means career jeopardy , then this is it Very interesting .

All right , y'all , we'll catch you guys on the next episode of Docs Outside the Box . Y'all , we love you all . Make sure you write in so that we can read your comments on the next episode , all right , yeah , what y'all say Fridays .