I Am Livid. And I Am Done.

I received a letter from UnitedHealthcare this week that I cannot stop thinking about.

It informed me that my colonoscopy was covered. Great news, right? Except buried in the fine print was the condition that made the coverage real: it was only covered if performed at an independent outpatient facility.

Not the hospital-based facility where my gastroenterologist performs the procedure. Not the place my colleagues use. Not the setting that is standard in my area. An independent outpatient facility, which, in my region, essentially does not exist for this procedure.

I pay $900 every month for this insurance. Nine hundred dollars. And what that buys me, apparently, is coverage for the procedure itself while the room, the facility, the care team, and everything surrounding the actual procedure remains my financial responsibility.

But here is the part that made my blood pressure rise above anything I would tolerate in a patient: the letter arrived after the procedure was already done. There was no warning before I scheduled it. No opportunity to navigate their requirements. No chance to find the phantom independent facility they apparently expected me to locate. Just a retroactive letter explaining, in the calm language of bureaucratic indifference, that my care did not qualify.

This is not a glitch. This is the design.

This Is the Game

I have been practicing medicine for thirty years. I have watched this system evolve from something imperfect but navigable into something that feels, on the worst days, deliberately punishing. The denials, the delays, the partial approvals that arrive after care has already been rendered. The prior authorizations for medications I have been prescribing safely for decades. The AI-driven denial engines that have never examined a patient, never sat across from a woman in tears because her symptoms have been dismissed for the fifth time, never once touched a human body in the context of healing.

People are not skipping colonoscopies, mammograms, and necessary follow-up care because they are irresponsible. They are skipping care because the system is unaffordable, unpredictable, and, I will say it plainly, intentionally confusing. Confusion benefits the insurer. Confusion leads to delayed care. Delayed care leads to denied claims. Denied claims lead to profit.

I am a physician. I understand the biology of disease. And I understand the biology of this system, too. It is not broken. It is functioning exactly as it was built to function.

That does not make it acceptable.

What I Am Done With

I am done fighting insurance companies for basic, medically necessary tests. I am done justifying clinical decisions to reviewers who have never practiced medicine. I am done being a data collector rather than the doctor I was trained to be. I am done watching patients suffer, not because medicine failed them, but because an automated denial system decided their suffering was not yet expensive enough to justify coverage.

And I am done pretending that participating in this system, even reluctantly, even with the best intentions, does not make me complicit in it.

Leaving insurance-based primary care is one of the hardest decisions I have made in my professional life. I am acutely aware that some of my patients do not have the resources to follow me into a direct pay model, and that grief is real. I do not take it lightly. I carry it with me. But I have reached the point where staying in a system that actively harms the people I am trying to help is no longer something I can justify in good conscience.

What I Am Building Instead

Wild Woman Wellness Medicine exists because I believe medicine should be practiced free from the games, the loopholes, the retroactive denials, and the invisible middlemen who profit from the space between a physician and her patient.

Direct Primary Care means I am supported by the people I support. No insurance company sits between us deciding what care you deserve. No rushed visits driven by billing codes. No prior authorization for the conversation you have been needing to have for three years. Just medicine practiced the way it was always meant to be practiced, rooted in relationship, in time, in the radical simplicity of one physician who knows you and is fully present for your care.

Is it perfect? No. Is it accessible to everyone? Not yet, and that limitation is something I think about constantly. But it is honest. And after thirty years of working inside a system that is neither honest, it feels like the most important place to begin.

I am done with the fight.

I am choosing the model that honors both my patients and the physician I have always wanted to be.

If you are tired too, come find me. There is a better way.