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.

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 Patients deserve care that isn’t dictated by outdated billing codes.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.

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💙

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.

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.

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.