UnitedHealthcare CEO's demise sparks numerous posts on social platforms, focusing on alleged insurance claim rejections
In a stark example, a Facebook post by UnitedHealth Group expressing sorrow over UnitedHealthcare CEO Brian T.'s demise garnered 62,000 reactions – 57,000 of which were laughing emojis. UnitedHealth Group is the parent company of UnitedHealthcare, the division that T. oversaw.
Police in New York are still working on identifying the assailant and their motive, but in an interview with NBC, T.'s widow, Paulette, mentioned some potential threats against her husband. She didn't provide further details.
A source informs CNN about some worrying threats against UnitedHealth Group, although T.'s name wasn't mentioned in these threats.
A bullet casing recovered from the scene of the shooting contained the words "depose" and "delay" written on it, according to law enforcement sources. Authorities are examining if these words offer a hint into the motive as they are somewhat similar to the title of a book criticizing the broader insurance industry – "Delay Deny Defend."
A significant number of insured U.S. adults have encountered difficulties, including claim denials, with their health insurance within a year, according to a survey presented by KFF in June 2023, a nonprofit health policy research organization.
Limitations on care access due to claim denials have been a persistent frustration, stated Kaye Pestaina, KFF's director of Program on Patient and Consumer Protections.
The primary association for health insurers criticized some of the social media reactions.
"Industry professionals in our field are dedicated to making coverage and care as affordable as possible and helping people navigate the complex medical system," Mike Tuffin, CEO of trade association AHIP, said in a statement. "We condemn any suggestion that threats against our colleagues – or anyone else in our country – are ever justified."
UnitedHealthcare stated that its top priorities are to support T.'s family, ensure the safety of its employees, and cooperate with law enforcement to apprehend the gunman.
"At UnitedHealth Group, we will continue to be there for those reliant on us for healthcare," their statement said. Other insurers did not respond to requests for comment.
Social media backlash
Following the announcement of T.'s death, users on social media swiftly began sharing their frustrations with UnitedHealthcare and other insurance providers.
"UnitedHealthcare denied my surgery two days before it was scheduled. I was in the hospital finance office in tears (when I was supposed to be at the hospital for pre-op stuff)," one user wrote in an X post that received more than 70,000 likes. "My mother was flying out to see me. My surgeon spent a day and a half lobbying United – she probably should have been caring for her other patients," the user continued, before mentioning that the surgery eventually went ahead but described the process as "torture."
"My breast cancer surgery was denied by a different insurance company," another X user posted. "Breast cancer. She asked me 'well, is it an emergency?' I don't know – it's (expletive) cancer. What do you think? I had to appeal, and luckily it was approved."
These stories were not independently confirmed by CNN.
TikTokker and anesthesiologist Brian Schmutzler mentioned in a video that the shooting brought up broader issues with insurance companies.
"From my perspective, we have a bigger issue with the insurance companies in general, who basically exist to make money, not to pay for healthcare," Schmutzler said.
Dreadful denials
It's not uncommon for Americans and their doctors to jump through numerous hoops to get approval for the care doctors recommend or to combat denials from insurance providers.
"This is care that doctors recommend for their patients, and some of this care can be frightening," Sara Collins, senior scholar at The Commonwealth Fund, a health policy foundation, told CNN, describing cancer diagnoses as an example. "To get any kind of denial or delay while your insurer decides whether or not they will cover it is truly frightening for people. To have a decision suddenly being decided based on financing is devastating for families."
Nearly one in five insured adults faced claim denials during a 12-month period, according to KFF's 2023 survey. Those with job-based insurance or ACA policies encountered this issue about twice as frequently as those covered by Medicare or Medicaid, whose denial rates were about one in 10.
Restricting access to healthcare through tools like claim denials and prior authorization, which requires approval before providing care, are some of the ways that health insurers attempt to eliminate unnecessary or unproven care – but it can also bolster their profit margins. The practices, which increasingly rely on technology, such as AI, often irk patients and providers alike.
A class action lawsuit filed last year in US District Court in Minnesota accuses UnitedHealthcare of using AI "instead of real medical professionals to wrongfully deny elderly patients care," according to the complaint. The lawsuit alleges that more than 90% of the denials are later overturned in an internal appeal or through proceedings before federal administrative law judges.
UnitedHealthcare petitioned the court to dismiss the lawsuit, arguing that the plaintiffs must first exhaust the administrative appeal process set by the Medicare Act, among other reasons.
The denial of claims can result in significant problems for patients, both in terms of care and finances.
Last year, UnitedHealthcare settled a dispute with a seriously ill college student in Pennsylvania, who claimed the company refused to cover necessary drugs recommended by his doctors, resulting in a medical bill exceeding $800,000. This was highlighted in an article by ProPublica. Evidence unveiled the extensive measures the insurer takes to reject claims, such as concealing medical reports and relying on biased doctors' endorsements, paid by the company itself.
The KFF survey revealed that around a fourth of claim denials by insurance companies led to substantial delays in medical attention for approximately the same amount of consumers. About twenty-five percent of these individuals reported a decline in their health due to these delays.
The emotional toll of postponing treatment due to insurance denials can affect patients' mental health as well. According to a 2023 Commonwealth Fund survey, 80% of adults reported feelings of worry or anxiety due to delays in care, affecting themselves or their family members.
Few individuals challenge insurance companies when their claims are denied. Just 43% of adults stated they or their doctor have contested the insurer's rejection, as per the Commonwealth Fund survey. Forty-five percent of them were unsure if they had the right to appeal, while 40% were uncertain whom to contact. Nearly one-quarter stated they lacked the time.
However, challenging the denial can bring results. Fifty percent of those who appealed ultimately received approval for their treatment, as per the Commonweal Fund survey.
Unjust denials in Medicare Advantage
Unjust rejections of services and payments by Medicare Advantage insurers, such as UnitedHealthcare, have raised concerns recently, particularly from the Department of Health and Human Services, which oversees the program, and some congressional representatives.
The insurers, compensated by the federal government to supply Medicare services to enrollees, have on occasion delayed or denied beneficiaries access to medical care, despite fulfilling Medicare coverage requirements, according to a 2022 report by HHS' inspector general's office. Annual government audits have flagged "widespread and persistent problems related to unjust denials of services and payment," the office said.
A major concern is the potential profit incentive for Medicare Advantage plans to deny access to services and payments to providers in order to boost profits. Insurers receive a set amount of money per patient, irrespective of the quantum of care provided.
UnitedHealthcare has particularly attracted scrutiny for drastically increasing care denials for its Medicare Advantage enrollees.
The company more than doubled the rate of denials for care following hospital stays between 2020 and 2022, utilizing automated technology to automate the process, according to a Senate Permanent Subcommittee on Investigation's report published in October. This far exceeded its rivals, including Humana, whose care denials grew 54% during the same time period.
“Despite ongoing concerns about misconduct and excessive practices, insurers have continued to deny care to vulnerable seniors—all in the pursuit of higher profits,” Connecticut Sen. Richard Blumenthal, who chairs the subcommittee, said in a statement in October.
CNN’s Jamie Gumbrecht, Majlie de Puy Kamp and Daniel Medina contributed to this report.
In light of the concerns raised about insurance denials, the primary association for health insurers, AHIP, defended its industry, stating, "Industry professionals in our field are dedicated to making coverage and care as affordable as possible and helping people navigate the complex medical system."
Despite UnitedHealth Group's efforts to ensure the safety of its employees and cooperate with law enforcement, the business has been embroiled in various controversies relating to claim denials and its use of AI to review claims. According to a class action lawsuit, UnitedHealthcare's AI system is accused of wrongfully denying elderly patients care, a claim the company is contesting.
