In January, Dr. Elisabeth Potter was in the middle of a breast reconstruction surgery when her phone buzzed with an unusual request. A representative from UnitedHealthcare, the country’s largest health insurer, wanted to talk about the patient on her table — right then and there.

Potter, a plastic surgeon in Austin, told NBC News she stepped out of the operating room to take the call. The rep asked her to justify why the patient needed to stay in the hospital overnight, even though the surgery itself had already been approved. “If they can ring me in the operating room, not for something urgent, just for that, and to ask me to justify her staying overnight,” Potter said later, “we have lost our way.”

All of this came to light in a viral TikTok video posted by Potter. After racking up millions of views, the video was just one among many where doctors aired their frustrations dealing with the bureaucracy of the insurance industry. Potter believes that by airing her grievances against UnitedHealthcare she became public enemy number one. She says that her surgery center, RedBud Surgery, was blocked from joining its in-network provider list.

UnitedHealthcare disputes that account. A spokesperson said the company “would never expect a physician to interrupt patient care” and that the decision not to contract with her center was made months before she posted the video. The company said its network in Austin already has a sufficient number of facilities.

That dispute leaves Potter in a precarious position. Though she personally remains in network when operating at hospitals, her clinic is considered out of network, which makes it financially untenable for many patients. Potter says she’s now $5 million in debt, her husband has cashed out his retirement savings, and she’s not taking a salary. “I’m just trying to do surgeries that women need in the best way possible,” she said.

A 2021 analysis from KFF found insurers denied about 17 percent of claims even when care came from in-network providers.

Ethicists like NYU’s Arthur Caplan argue that the current system — with private companies deciding what care gets covered — is “ridiculously immoral.” And yet, as long as the U.S. leans on private insurers to manage costs, disputes like Potter’s will remain a fixture of American medicine.

For now, Potter is still fighting to keep her doors open. “All I want,” she said, “is for patients who are medically appropriate to have their surgeries here. Same care, less expensive for the system. That’s it.”