Concern over UnitedHealthcare’s (UNH) allegedly high claim denial rate is growing. However, the full scope of its denials is still unknown, particularly with regard to private plans, because insurers attempt to conceal these figures.
The company’s CEO, Brian Thompson, was shot and killed in New York City on Wednesday morning, just hours before he was scheduled to speak at the healthcare company’s annual investor day, which has led to increased scrutiny.
On Thursday, several media outlets reported that the words ‘deny,’ ‘defend,’ and ‘depose’ were inscribed on shell casings from the shooting. Some have hypothesized that these terms are ones used by industry critics to characterize the strategies used by insurers to reject claims.
At the same time, social media posts have claimed that UnitedHealthcare has the highest claim denial rate in the industry, at 32 per cent, according to an X post, crediting Value Penguin analysis. According to Value Penguin, a personal finance website, this rate was determined using available in-network data from marketplace-sold plans.
United healthcare market cap and reach
Having a market value of over USD 500 billion, UnitedHealthcare is the biggest private health insurer in the United States and a part of the UnitedHealth Group. Through health benefit plans, its largest company, UnitedHealthcare Employer and Individual, provides services millions of Americans.
Data on claim denials
The federal government has not yet gathered much of this data and has shared even less with the public, despite the Affordable Care Act allowing regulators to mandate insurers to share information on denials of claims, according to a 2023 report.
Claim Denial rate
According to a report released in August by the non-profit health policy research group KFF, all Medical Advantage insurers denied 7.4 per cent of prior authorization requests (requests for coverage of specific medical services) in 2022, up from 5.4 per cent in 2019.
