UnitedHealthcare Denies More Claims Than Other Insurers — Angering Patients And Health Systems

Today on Forbes, UnitedHealthcare denies more claims than other insurers, angering patients and health systems. The bullet casings from the ammunition that killed UnitedHealthcare CEO Brian Thompson reportedly had three words written on them, quote, deny, defend, and depose. These words allude to the strategy that some attorneys and critics have used to describe the tactics used by health insurance companies And the most recent available data suggests that UnitedHealthcare, or UHC, is perhaps the country's worst offender. When it comes to denying claims, multiple reports suggest that UHC, which is the country's largest health insurer and serves some 50 million people, is an industry leader, with a rate nearly double the industry average. A recent Senate report slammed the company for denying nursing care to And it currently faces a class-action lawsuit for its use of AI algorithms to automatically refuse payment. The insurance giant's tactics have frustrated patients and health care providers alike. A major protest at the company's subsidiary Optum's headquarters in Minnesota in July attracted roughly 50 demonstrators, 11 of whom were arrested. Disputes with hospital systems over UHC's claim denials have led to some deciding not to accept its insurance at all. Insurance insights firm ValuePenguin told Forbes that as there's no central repository of this data. But according to one of the firm's reports on insurance claim denial rates, UHC has the highest instance of denials out of all major providers, refusing an estimated one-third of claims submitted. The insurer did not respond to a comment request. UnitedHealthcare also has the largest market share of health insurance policies, with roughly $215 billion in revenue. ValuePenguin said that For example, a middle-tier plan with UHC would cost a 40-year-old person $631 per month, whereas the national average would amount to an estimated $621 per month. The shooting has reignited a national conversation about America's for-profit health care sector and many people's inability to afford treatments and medication. Healthcare.gov issuers denied a total of 17% of claims in 2021, with some issuers' denial rates reaching 49%. according to a 2023 report by health researcher KFF. In a 2023 survey of consumers' experience with their health coverage, KFF found that UnitedHealthcare announced a new policy, effective December 1, by which it may deny charges for inpatient or outpatient services that it considers which would give the insurer more opportunity to issue denials around specific line items, according to health care attorneys at Davis Wright Tremaine. The UHC CEO was shot and killed as he was on his way to a Manhattan investor meeting for parent company UnitedHealth Group around 6.45 a.m. last Wednesday. In the hours after, anger and frustration over insurance denials and medical costs bubbled up online and in conversations. One angry poster wrote on X, formerly Twitter, Thompson's wife, Paulette, told NBC News last Wednesday that she was aware he had received some threats. She said, At the Forbes Healthcare Summit in New York last week, attendee Michael Patton, founder and president of Accel Health Plans, said his initial reaction was that the shooting may have been related to someone whose claim had been denied, given the anger such an experience can cause. As of this recording, police are still searching for the suspect, and his motivation remains a matter of conjecture. For full coverage, check out Amy Feldman and Alex Knapp's piece on Forbes.com. This is Kieran Meadows from Forbes. Thanks for tuning in.