UnitedHealthcare (UNH) is going through rising scrutiny for its allegedly excessive declare denial price. Nonetheless, since insurers attempt to hold these numbers hidden, the true extent of its denials stays unsure, particularly relating to personal plans.
The heightened scrutiny comes as the corporate’s CEO Brian Thompson was fatally shot in New York Metropolis on Wednesday morning, simply hours earlier than he was set to talk on the healthcare agency’s annual investor day.
A number of shops reported on Thursday that shell casings from the taking pictures had the phrases “deny,” “defend,” and “depose” written on them. Some have speculated that these phrases check with phrases business critics use to explain ways that insurers make use of to disclaim claims.
On the similar time, posts on social media have been claiming that UnitedHealthcare’s declare denial price is the highest within the business at 32%. This determine comes from the private finance web site Worth Penguin, which mentioned it calculated that price from out there in-network knowledge from plans offered on {the marketplace}.
UnitedHealthcare didn’t instantly reply to a request for remark from Quartz. UnitedHealthcare is a division of UnitedHealth Group and the biggest personal well being insurer within the U.S. with a market cap north of $500 billion. Its greatest enterprise, UnitedHealthcare Employer and Particular person, serves greater than 29 million Individuals via well being profit plans.
Though the Inexpensive Care Act permits regulators to require insurers to share info on declare denials, the federal authorities has up to now not collected a lot of this knowledge and has shared even much less with the general public, in keeping with a 2023 report from ProPublica.
Nonetheless, some latest studies present that denials have been on the rise.
In October, a report from the U.S. Senate Everlasting Subcommittee on Investigations confirmed that the nation’s insurers have been utilizing AI-powered instruments to disclaim some claims from holders of Medicare Benefit plans.
The report discovered that UnitedHealthcare’s denial price for post-acute care — well being care wanted to transition folks out of hospitals and again into their properties — for folks on Medicare Benefit plans rose to 22.7% in 2022, from 10.9% in 2020.
In August, a report from the well being coverage analysis non-profit KFF discovered that every one Medical Benefit insurers absolutely or partially denied 7.4% of prior authorization requests — requests for protection of particular medical companies — in 2022, up from 5.4% in 2019.
