Dr. Elisabeth Potter

Now she has to wait again, just long enough to age out of the plan and onto Medicare.

It makes you wonder doesn’t it? How many decisions like this are about care? And how many are about cost?

He submitted everything—her imaging, her full records, all the evidence. But United denied the case…because he didn’t include the radiographic findings in the body of his note.

Not because she didn’t need the surgery. Not because the data wasn’t there. But because of a formatting technicality.

This morning I was prepping for a DIEP flap when an orthopedic surgeon sat down beside me and said, "You're not gonna believe what United just did."

His patient had waited six months just to see him. He confirmed she needed a hip replacement & she was a good candidate.

If we want better outcomes, we need to demand better systems. Patients deserve care that isn’t dictated by outdated billing codes. They deserve full, uncompromised care—not the cheapest version insurance is willing to cover.

This is the reality of our healthcare system. Surgeons are forced to down-code, compromise, or absorb the cost, just to get patients what they need.

But when we accept this, we devalue our work. And worse, we devalue our patients.

It’s wrong. And it’s not sustainable.

She has Medicaid and I take Medicaid. I’m ready to do the surgery. But Medicaid won’t pay for it.

They’ll only reimburse me to use HALF of her belly. Even though that won’t give her the reconstruction she needs. Even though using all of her tissue is the medically appropriate option.

I have another crazy story for you.

Last week, I met with a young patient who only has one breast after mastectomy and radiation. She can’t have an implant. She needs a complex reconstruction called a stacked DIEP flap—using all of her belly tissue to create one breast.

Healthcare shouldn’t have to be this hard. And I’m fighting every day to make it better. But in the meantime, just know: I see you. I see the hustle. And you have my deepest respect💙

It feels like I've been going a million miles an hour operating, working & going to conferences.

But I just wanted to say, I love this work so much, & I love the people in healthcare.

I am so grateful for the nurses, the techs, & team who keep showing up—despite the obstacles.

No matter how hard I try to protect patients from harm, it’s getting harder.

So now I’m reevaluating ways around this, because our patients deserve better.

Let’s discuss why we have “in network” and “out of network” designations. Does this add value?

If I don’t fight for approvals & navigate the system, patients can be left with crushing bills. So I don’t have the privilege of ignoring insurance.

But the truth is, the system that delivers healthcare in the US is broken.

If I want to care for patients in the U.S., I have to care about insurance. Americans have been paying premiums with an expectation that coverage will provide access to the care they need & choose.

A breast cancer diagnosis isn’t just physically devastating, it can be financially devastating too.

The sad reality is I can’t afford to keep doing this for patients, even though I want to

We need a better system for patients and for the doctors trying to care for them.

I believe we can fix this. But we need the help of the government. We need laws to change, & we don't have the luxury of time.

But here’s the thing: this isn’t a one-off. This is yet another example of how having insurance doesn’t mean you have access to care. These narrow networks are failing patients. This young woman has cancer now. She needs surgery now. And we don’t have the luxury of time to wait for policy change.

The breast surgeon called me & asked for a favor, knowing I take cases like this on, even if the payments are low…too low to cover the costs for me and my practice…because I think it’s the right thing to do.

My team is doing everything we can to get her seen this week and to get her case approved.

Last night, I got a late call from a breast surgeon here in Austin, TX. Her 22-year-old patient— just days away from a mastectomy—found out the plastic surgeon she had been seeing is out-of-network and her insurance doesn’t cover any out-of-network care.

So now what?

It’s about value. In relationships. In medicine. In life. No one will value you if you don’t value yourself. And as physicians—and as patients—we’ve been giving it away for free for too long.

It’s time to reframe the system. To remember our worth. And to start demanding it.

I’ve been complicit in that. Accepting their numbers. Letting them define the value of surgeries that change lives.

But here’s what I know now: if someone thinks a DIEP flap is worth $2,700, we’re not speaking the same language.

This isn’t just about money.

If you don’t know where you are, how can you know how to get where you’re going?

Lately, I’ve been thinking a lot about how we got here. How we let insurance companies that don’t understand the complexity of our work decide what it’s worth.

For the doctors out there: It’s time we talk about how unfair the business of medicine has become for providers. If you’ve tried to negotiate fair pay with insurance—whether it worked or not—I want to hear your story. Tag me or share it in the comments. We can’t fix what we don’t talk about.

Her insurance company denied a stay for a surgery without even knowing what the surgery IS.

I’ve been asked—yet again—to stop in the middle of my surgery day and justify why a patient scheduled for DIEP flap needs an overnight hospital stay. While I’m in the OR doing the hard work of breast reconstruction, I’m also expected to fight the system outside of it.

Sharing this email from the insurance company for transparency. Insurers are not medical providers yet they’re dictating when I can operate based on arbitrary policies. This delay isn’t just frustrating. It’s harmful to my patient. Insurance should not be allowed to practice medicine.

I’m the microsurgeon and insurance companies are telling me when to operate. Insurance companies are practicing medicine—and that’s not okay. Make it make sense.

Stepped out of a new patient’s consult for a peer to peer at the only time United offered me. You may remember an insurance company recently insisting that they’d never interrupt patient care for insurance matters. Reality check, it happens all the time...

We’ll keep sharing these stories—because this shouldn’t be normal. Patients deserve better. Providers deserve better.

And without a reference number, there’s no way to track it, no accountability, and no clear path forward. All we have are the first names of the representatives who hung up.

This happens often. And it’s exhausting. But we won’t stop showing up for patients.

trying to add procedure codes so patients can receive coverage for sensation preserving mastectomies.

Twice now, after 30+ minutes on the line, the call just ends. No reference number. No resolution. Just—terminated.

Our team has two incredible, full-time professionals—Mary and Ebonie—dedicated to dealing with insurance. They advocate for our patients, so our patients can focus on healing.

This week? They’ve been on repeat calls with the same insurer…

📣 It’s not a perfect bill (I want this everywhere, not just in rural areas) But it’s a step in the right direction. And your voice matters—for patients, for providers, for all of us.

Link in my bio to take action 💪