Flags fly at half-mast outside United Healthcare headquarters Brian Thompson, CEO of United Healthcare, was shot dead on the street in New York City.
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TThe shell casings of the ammunition that killed UnitedHealthcare CEO Brian Thompson reportedly had three words written on them: “Deny,” “Defend” and “Depose.” These words refer to the strategy that some advocates and critics have used to describe the tactics used by health insurers to deny payment of claims – and the latest available data suggests that UHC may be the nation’s worst offender.
When it comes to claim denials, multiple reports suggest that UHC, the nation’s largest health insurer serving some 50 million people, leads the industry, with a rate nearly double the industry average. A recent Senate report has condemned the company for denying nursing care to patients recovering from falls and strokes under its Medicare Advantage plans, and the company is currently facing a class action lawsuit due to the use of AI algorithms to automatically deny payments.
The insurance giant’s tactics have frustrated patients and providers alike. A big protest at the headquarters of subsidiary Optum in Minnesota was hired in July about 50 demonstratorsof whom 11 were arrested. Disputes with hospital systems over UHC’s claim denials have led some to decide not to accept the insurance at all.
Measuring the exact number of denied claims is difficult because there is no central repository for this data, insurance insights firm ValuePenguin told us. Forbes. But according to one of the firms reports In terms of insurance claim denials, UHC has the highest denial rate of any major provider, with an estimated one-third of claims submitted being denied. The insurer did not respond to a request for comment.
UnitedHealthcare also has the largest market share in health insurance, with revenues of approximately $215 billion. ValuePenguin said that based on current insurance plan costs, UHC offers the most expensive premiums in the country compared to other providers. For example, a mid-range plan with UHC would cost a 40-year-old person $631 per month, while the national average would be an estimated $621 per month.
The shooting has reignited a national conversation about America’s for-profit health care industry and the inability of many people to afford treatments and medications. HealthCare.gov issuers denied a total of 17% of claims in 2021, with some issuers’ denial rate reaching 49%, according to a 2023 report from health researcher KFF. In a 2023 survey of consumers’ experiences with their health coverage, KFF found that nearly half of adults with insurance problems are unable to resolve them satisfactorily, with 15% saying their health is deteriorating and 28% saying they paid more than they expected.
An unidentified man shot and killed Thompson as he headed to an investor meeting in Manhattan for parent company UnitedHealth Group around 6:45 a.m. on Wednesday. In the hours that followed, anger and frustration over insurance denials and medical costs bubbled up online and in conversations. “If you shoot one man on the street, it’s murder. If you kill thousands of people by depriving them of the opportunity to get treatment, you are an entrepreneur.” an angry poster wrote on X, formerly Twitter.
Thompson’s wife Paulette told NBC News on Wednesday that she knew he had received the letter some threats. “Actually, I don’t know, a lack of cover?” she said. “I don’t know the details. All I know is that he said there were people threatening him.”
At the Forbes Healthcare Summit in New York on Wednesday, attendee Michael Patton, founder and president of Excel Health Plans, said his initial reaction was that the shooting may have been linked to someone whose claim had been denied, given the anger such an experience can cause . cause. Police are still looking for the suspect and his motivation remains a mystery.
The company is facing multiple lawsuits over the denials. Last November, the estates of two deceased Medicare Advantage patients were sued indicted UHC, claiming their claims for care were denied using an AI model with a “90%” error rate. (UnitedHealth had argued that the lawsuit should be dismissed because patients have not completed their appeals.) In October 2024, the Senate Subcommittee on Investigations published a report which showed that the company used algorithms to deny claims and “knew from testing that at least one of these automation technologies resulted in an increase in rejected requests.”
UnitedHealthcare’s practices have also been a source of tension with hospitals and health care systems in recent years. For example, New England-based Trinity Health briefly dropped UHC earlier this year over a number of issues, including the fact that it initially denied more than 10% of its Medicare Advantage claims. The parties reached an agreement in August, but it is certainly not the only system that has had problems with the insurer. According to Becker’s Hospital Review, six healthcare systems dropped the insurer in 2024.
After months of negotiating with the University of Florida Health System to renew their contract, the two entities were unable to reach an agreement, and UHC dropped the health care system from coverage in September. UF said in a statement that the insurer wanted to pay below market rates for health care services (UHC said the rates were “market competitive”), and that “lengthy prior authorization processes, complicated billing and coding requirements, and denials/payment delays have resulted in reductions” in UHC payments.
Delays and denials from UHC also frustrated its relationship with Duke Health, whose CEO said as much in an interview earlier this year that the insurer “has been 57% slower in paying claims than our other payers and is taking more than 60 days to respond to claims they deny.”
United Healthcare announced a new policy, effective December 1, which will allow it to deny charges for inpatient or outpatient services it considers “routine” – which would give the insurer more ability to issue denials around specific items, according to to healthcare attorneys at Davis Wright Tremaine.
“Health care should be easier for people,” Thompson, 50, said at an investor meeting last year. He became CEO of UHC in April 2021 and received total compensation of $10.2 million, according to the proxy statement of the company. Thompson joined UnitedHealth Group in 2004 and previously served as head of government programs, including Medicare.
UnitedHealthcare wasn’t the only insurer to face consumer wrath this week. Anthem Blue Cross Blue Shield said yes deny anesthesia claims that took longer than the specific time limits it set for operations starting in February. After an outcry, the insurer said it would not go ahead with its policy change.
Sarah Emerson contributed reporting.
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