A New York plastic surgeon just took to Instagram and TikTok to share his frustrations after a peer-to-peer conversation with Anthem Insurance. Dr. Tomer Avraham has been treating a patient who is suffering from severe Poland syndrome. However, when they reached out to Anthem regarding a breast reconstruction surgery, it was allegedly denied. Then, the peer-to-peer went sideways. His resulting vent went on to rack up 180K views in just two days. Avraham stated in his post, “So I kind of hate to do this because I feel like we’re being inundated with these videos and I hate to be just one more voice, but I’m pretty fired up. So I kind of had to. I’ll use this as a video diary for therapy.” He went on to describe the reality for his patient, saying, “So she’s basically got one breast that’s absent. And she has this really gross asymmetry and makes it, uh, very difficult for her, uh, to function on a day-to-day basis.” Per the Cleveland Clinic, Poland syndrome is a rare condition present at birth where the chest muscles on one side of the body don’t form properly. It can lead to an uneven or sunken chest appearance. It may also impact breast tissue, ribs, or even the arm and hand on that same side. While some cases are mild, others can significantly impact a person’s daily life, and reconstructive surgery is often the standard route for improving both function and appearance. A difference in categorization Avraham pointed out, “Like think about how she could wear a bra, how she can really wear, um, most items of clothing without being exposed to a lot of embarrassment and difficulties in addition to any challenges with neck and back and shoulder pain related to asymmetry.” Despite this stated medical need, Anthem denied the surgery, allegedly labeling it as cosmetic. Avraham was particularly frustrated by his ‘peer.’ He told his viewers, “And, you know, I had a peer-to-peer with an emergency room physician who’s not really a peer when it comes to this issue.” It should be noted that all we have is his perspective. Since there is no statement from Anthem, the post should not be treated as verifiable fact. View this post on Instagram According to his post, Avraham went on to challenge his peer. He claimed, “And, um, I asked them what would be the difference if, for example, she was missing her nose? You don’t need a nose to live to breathe just fine. Uh, but presumably insurance will cover reconstruction, and he didn’t have an answer. He just said, you know, this is my policy. I’m not approving this. You can appeal.” The reaction online was wildly supportive. One TikToker simply asked, “What’s the point in having insurance?” Another user, who identified as having the same condition, wrote, “As someone with Poland syndrome, I had a plastic surgeon fight for me 13 years ago and it got covered.. I can only imagine the soul sucking kind of fight it is now.” In one famous case, a surgeon had to scrub out mid-surgery to justify the same to United Healthcare. Avraham provided a short update the next day, noting that the social media attention actually forced a change with Anthem. He claimed, “Speaking to the power of social media! Uh, Anthem reached out to me. That their social media team had taken note, and they want to get some information to see if we can, uh, help, uh, resolve the issue.” However, he remained cautious about the process. @dr.tomeravraham I want to thank everyone for all of the support. It’s disheartening to read so many similar stories, and it’s very clear that we need to continue this conversation. #healthinsurance ♬ original sound – Dr. Tomer Avraham He told his viewers, “I told them, uh, that they need to FAX me a request for records because obviously I can’t give them a patient name, patient information, uh, over the phone without knowing who I’m speaking to.” The doctor also highlighted the broader, systemic problem he faces regularly when it comes to insurance. Avraham said, “But, you know, this has become a more and more onerous process. We have more and more of these peer-to-peers that we have to do. And more often we are not getting, uh, true peers, uh, colleagues in our specialty. For some insurance companies, we don’t even get to know what the, uh, physician that’s doing the peer review, what their, uh, name is or their specialty. We don’t have any identifying information, uh, whatsoever.” For many, the update was a clear sign of a broken system. One Instagram user noted, “Isn’t it sad that social media matters more to anthem than the opinion of the board certified physician taking care of the patient. just hope the social media traction helps your patient the care she deserves!” On that topic, Avraham made it clear that he’s not backing down. He stated, “We’ll keep appealing. Hopefully we can get that overturned.”