Flags fly at half-mast outside United Healthcare headquarters United Healthcare CEO Brian Thompson was shot dead on the street in New York.
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TBullet casings from the ammunition that killed UnitedHealthcare CEO Brian Thompson reportedly had three words written on them: “Denial,” “Defense,” and “Deposition.” Those words echo the strategy some lawyers and critics have used to describe the tactics health insurance companies use to deny payment for claims — and the most recent data available suggests UHC may be the nation’s worst offender.
When it comes to denying claims, many reports suggest that UHC, which is the nation’s largest health insurer and serves about 50 million people, leads the industry, with a rate nearly double the industry average. A recent Senate report criticized the company for denying nursing care to patients recovering from falls and strokes in its Medicare Advantage plans, and is currently facing a class action to use AI algorithms to automatically decline payment.
The insurance giant’s tactics have frustrated patients and healthcare providers. A great protest at the headquarters of its Optum subsidiary in Minnesota in July attracted about 50 protesters11 of whom were arrested. Disputes with hospital systems over UHC’s claim denials have led some to decide not to accept its insurance at all.
Measuring the exact number of claim denials is difficult because there is no central repository of that data, said insurance information firm ValuePenguin Forbes. But according to one of the companies exhibitions in terms of insurance claim denial rates, UHC has the highest denial rate of all major carriers, denying approximately one-third of claims submitted. The insurer did not respond to a request for comment.
UnitedHealthcare also has the largest share of the health insurance market, with revenue of about $215 billion. ValuePenguin said that based on current plan costs, UHC offers the most expensive premiums in the country compared to other providers. For example, a mid-tier plan with UHC would cost a 40-year-old $631 per month, while the national average would be about $621 per month.
The shooting has reignited a national debate about America’s for-profit health care sector and the inability of many people to afford treatments and drugs. HealthCare.gov issuers denied a total of 17% of claims in 2021, with some issuers’ denial rates as high as 49%, according to Report 2023 by the KFF health researcher. In a 2023 survey of consumers’ experience with their health coverage, KFF found that nearly half of adults who had insurance problems were unable to resolve them satisfactorily, with 15% saying their health deteriorated and 28% saying they paid more than they expected.
Another unidentified man shot and killed Thompson on his way to an investor meeting in Manhattan for parent company UnitedHealth Group around 6:45 a.m. Wednesday. In the hours that followed, anger and frustration over insurance denials and medical bills erupted online and in chats. “When you shoot a person in the street, it’s murder. When you kill thousands by taking away their ability to receive treatment, you are an entrepreneur.” one angry poster wrote to X, formerly Twitter.
Thompson’s wife, Paulette, told NBC News on Wednesday that she knew he had received some threats. “Basically, I don’t know, lack of coverage?” she said. “I don’t know the details. I just know 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 might be related to someone whose claim had been denied, given the anger that such an experience can cause. cause. Police are still looking for the suspect and his motive remains speculative.
The company faces multiple lawsuits over its denials. In November of last year, the estates of two deceased Medicare Advantage patients sued UHC, claiming their claims for care were rejected using an AI model with a “90% error rate.” (UnitedHealth had supported that the lawsuit should be dismissed because the patients did not exhaust their appeals.) In October 2024, the Senate Subcommittee on Investigations published a report which found 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 the share of those claims that were denied.”
UnitedHealthcare’s practices have also been a source of tension with hospitals and health care systems in recent years. Trinity Health of New England, for example, briefly withdrew UHC earlier this year over a number of issues, including the fact that it initially denied more than 10% of Medicare Advantage claims. The parties reached a settlement in August, but it’s not the only system that has had problems with the insurer. According to Becker’s Hospital Review, six health systems withdrew the insurer in 2024.
After months of negotiations 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 system from its coverage in September. UF he said in a statement that the insurer wanted to pay below market rates for health care services (UHC he said its rates were “market competitive”) and that “lengthy prior authorization processes, complex billing and coding requirements, and claim denials/payment delays have led to reductions” in payments from UHC.
The delays and denials from UHC also soured its relationship with Duke Health, whose CEO said in an interview earlier this year that the insurance company “was 57% slower to pay claims than our other payers and takes more than 60 days to respond to denied claims.”
UnitedHealthcare announced a new policy, starting Dec. 1, in which it can deny billing for inpatient or outpatient services it considers “routine” — which would give the insurer more opportunities to issue denials for specific line items; according to to health attorneys at Davis Wright Tremaine.
“Health care should be easier for people,” Johnson, 50, told an investor meeting last year. He became CEO of UHC in April 2021 and received total compensation of $10.2 million, according to company representative statement. Johnson joined UnitedHealth Group in 2004 and previously served as head of government programs, including Medicare.
UnitedHealthcare wasn’t the only insurer to face consumer ire this week. Anthem Blue Cross Blue Shield said it would deny allegations of anesthesia which lasted longer than the specific time limits he set for surgeries from February. After an outcry, the insurance company said it would not proceed with changing its policy.
Sarah Emerson contributed reporting.
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