As one of the nation’s largest health insurers, covering more than 50 million people, UnitedHealthcare has battled a range of complaints and investigations from patients, doctors and lawmakers for its denial of medical claims.
Those practices may face new scrutiny after law enforcement officials said that the bullet casings found at the site of the killing of the UnitedHealthcare chief executive Brian Thompson on Wednesday appeared to have messages, including the words “deny” and “delay,” written on them. The shooter’s motive and identity still remained unknown on Thursday, and no evidence has emerged that the killer was a UnitedHealthcare customer.
While the words “deny” and “delay” have multiple meanings, they could be a reference to the tactics used by insurers of all kinds to avoid paying claims. The words are so linked to those practices that they were used in the title of a 2010 book probing them, “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.”
“An insurance company’s greatest expense is what it pays out in claims,” wrote the book’s author, Jay Feinman, an emeritus professor at Rutgers. “If it pays out less in claims, it keeps more in profits.”
No one knows how often private insurers like UnitedHealthcare deny claims because they are generally not required to publish that data. People who bought coverage under Obamacare, a government-funded plan, had 17 percent of their care denied in 2021, according to KFF, a health policy group. Other surveys have found that denials are more prevalent among those with private insurance than those who carried government coverage.
UnitedHealthcare, part of the giant conglomerate UnitedHealth Group, reported more than $16 billion in operating profits last year and employed roughly 140,000 people. The company is a frequent lightning rod for criticism over how it handles claims.
Earlier this year, a Senate committee investigated Medicare Advantage plans denying nursing care to patients who were recovering from falls and strokes. It concluded that three major companies — UnitedHealthcare, Humana and CVS, which owns Aetna — were intentionally denying claims for this expensive care to increase profits. UnitedHealthcare, the report noted, denied requests for such nursing stays three times more often than it did for other services. (Humana had an even higher figure, denying at a rate 16 times higher.)
UnitedHealthcare did not respond to a request for comment about its history of claim denial.
Journalists have also scrutinized United’s denial practices. In January, the health news outlet Stat published a detailed investigation into how a UnitedHealthcare subsidiary, NaviHealth, used algorithms to deny care for seniors enrolled in the company’s Medicare advantage plan.
The Stat investigation noted specific instances that troubled United employees, like when an older woman who had a stroke was only covered for half the nursing days typically required for recovery.
UnitedHealthcare and its parent company now face a class-action lawsuit over its use of the algorithm. In response to the Stat article, the company issued a statement that “the assertions that NaviHealth uses or incentivizes employees to use a tool to deny care are false.”
A 2023 story from ProPublica dived deep into the experience of one United patient, a college student who racked up $2 million in medical claims a year to treat a severe case of ulcerative colitis. The story showed United disregarding an internal report finding the expensive treatment to be necessary. The patient eventually sued United and received an undisclosed amount in a settlement.
Insurance denials are rarely appealed, with some studies finding appeal rates of roughly 1 percent.
UnitedHealthcare, in response to the ProPublica story, said that the patient took his medication at dosages that “far exceed” Food and Drug Administration guidelines, which led the insurer to “review treatment plans based on current clinical guidelines to help ensure patient safety.”
Since the news of Mr. Thompson’s death on Wednesday, some individuals on social media have expressed frustration over the company’s history of denying claims. Others have gone even further, celebrating the death of a top insurance executive.
The insurance industry has pushed back against the outrage. “The people in our industry are mission-driven professionals working to make coverage and care as affordable as possible and to help people navigate the complex medical system,” said Michael Tuffin, the president of AHIP, a major trade group, on LinkedIn. “We condemn any suggestion that threats against our colleagues — or anyone else in our country — are ever acceptable.”
