Troubling symptoms
Writing in Medscape, health journalist Barbara Feder Ostrov notes that many physicians “reacted with the opposite of sympathy” upon learning of the fatal shooting of UnitedHealthcare CEO Brian Thompson. These doctors reflected “the pent up frustration and anger over what they described as the health insurer’s routine denials of care for sick and dying patients.”
One physician wrote of waiting “for a prior authorization before I shed a tear.” Another doctor recalled battling UnitedHealthcare over the denial of a low-cost drug. Women, the elderly and the poor are more likely to be denied treatment and/or medication than other gender, age and income groups.
A study by the Kaiser Family Foundation (KFF) found that even when patients received care from “in-network physicians,” hospitals and doctors that are covered by these insurers, the companies denied 17% of claims in 2021. One insurer denied 49% of claims that year while another denied 80% of claims in 2020.
The Boston Globe reported that in 2023 UnitedHealthcare had the worst claims denial record among all large health insurance companies, rejecting 32% of claims compared to an industry average of 16%.
In 2024 a Senate committee investigating Medicare Advantage plans found UnitedHealthcare, Humana and CVS (which owns Aetna) were intentionally denying “post-acute” nursing care for patients recovering from falls and strokes. The report concluded that UnitedHealthcare denied requests for such nursing home stays three times more than it did for other services. Humana had a denial rate for these services 16 times greater than for other services.
Health care insurance companies are using algorithms or employing people with little relevant insurance experience to issue a significant number of claim denials at a time, without reviewing a patients medical chart. A job title at one health insurance company was “denial nurse.”
Federal data indicates that health insurance companies denied more than 49 million claims in 2021. A ProPublica investigation found that global health insurance company Cigna has a system allowing its doctors to reject a claim on medical grounds without opening the patient file. In one two month period (2022) Cigna doctors denied over 300,000 requests for payments using this method.
Research by the non-profit Commonwealth Fund found that 60% of those who faced a coverage denial saw their care delayed while 47% said their health conditions worsened because of it.
A KFF study reported that 69% of consumers denied health insurance claims did not know they have appeal rights, and the vast majority (85%) did not file formal appeals. The KFF notes that “It’s hard to fight a big insurance company. To begin with you have to understand the gobbledlygook in the paperwork.”
Health insurance claim denials can be stressful, depressing, terrifying (especially when children are the patients), life-threatening, costly and absurd.
A Los Angeles man reported that he was shocked when payment for an arrhythmia condition which caused his heart to beat as fast as 300 times a minute was denied after he had been pre-approved for this $143,206 medical intervention. The rejection letter stated that treatment was denied because he had asked “for coverage for injections into nerves in your spine.” Neither the patient nor his doctor requested this procedure. Months after this rejection the situation remained unresolved.
An insurance company sent a letter directly to a newborn infant stating that coverage for his fourth day in a neonatal intensive care unit was denied because “You are drinking from a bottle” and “you are breathing on your own.” Unfortunately the child will not be able to contest this rejection until he learns how to read and write. No doubt his appeal will be denied because he waited too long.
Suffering from a life-threatening anaphylactic allergic shock reaction, a college student was given epinephrine shots and steroids in a hospital emergency room. The student’s mother received a claim rejection letter from the insurance company stating that her son’s treatment was “not medically necessary.”
Isaac Rosenbloom, a paramedic and 43-year-old father of four doesn’t know if he has cancer because his health insurer refused to approve an MRI after an X-ray revealed nodules on his lungs. Rosenbloom stated: “Do I have to wait until I start coughing up blood? Wait until its Stage 3 before the insurance company takes it seriously? And will it be too late then?”
A physician remarked that “While the murder of the UnitedHealthcare CEO is tragic, let’s remember that thousands of Americans die every year when United denies coverage. Violence is never the answer, but we do need to find lawful ways to hold insurance executives accountable for their greed.”
And greed it is. Industry research firm IBIS World ranks health and medical insurance companies as the tenth most profitable industry in the U.S. with estimated profits in 2024 of $131.4 billion. In 2023 CEOs of the six major national insurers received a combined $123 million in total compensation (salaries, stock options and various options awards). UnitedHealthcare CEO Andrew Witty was at the top of that list with a compensation package worth approximately $23.5 million.
Syndicated columnist Froma Harrop writes that when former UnitedHealthcare CEO William “Dollar Bill” McGuire (1991-2006) retired, he “walked off with a $1.1 billion golden parachute after having raked in $500 million.”
Sean King, an attorney and Connecticut health care advocate, notes that while these executives “are bringing home millions of dollars” annually, more than 40% of adults in the U.S. “are carrying medical debt they can’t pay” and “a third of Americans can’t cover emergency expenses of $400 or more …” National Public Radio reports that more than 100 million people in America are “beset by a health care system that is systematically pushing” them into debt.
Fatally shooting someone in the back is evil; so is delaying and denying individuals medical coverage via a healthcare system that prioritizes profits over people. The former is a crime while the latter is business as usual in corporate America.
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George J. Bryjak lives in Bloomingdale and is retired after 24 years of teaching sociology at the University of San Diego.
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Sources:
Abelson, R. (2023) “Insurers deny medical care for the poor at high rates, report says,” July 10, The New York Times, www.nytimes.com
Asare, J. G. “How the American healthcare system is failing its people” December 7, Forbes,
www.forbes.com
“Analysis: health insurance claim denials are on the rise to the detriment of patients” (2023) May 28, National Public Radio, www.npr.org
Feder Ostrov, B. (2024) “Physicians offer little sympathy for slain insurance CEO,” December 6, Medscape Medical News, www.medscape.com
Harrop, F. (2024) “Anger against insurers comes honestly,” December 10, Buffalo News, www.buffalones.com
Humble, W. (2023) Americans suffer when health insurers place profits over people,” August 10, Pennsylvania Capital-Star, www.penncapitalstar.com
Kliff, S. and R. Abelson (2024) UnitedHealhcare has faced scrutiny over denying claims,” December 5, The New York Times, www.nytimes.com
Levy, N. (2022) “Sick and struggling to pay, 100 million people in the U.S. live with medical debt,” June 16, National Public Radio, www.npr.org
Lunby, (2024) “No one should have to be fighting cancer and insurance at the same time,” December 12, AOL.COM, www.aol.com
“Medical bills account for 40 percent of bankruptcies” (2000) British Medical Journal, www.bmj.com
“Minemyer, P. (2024) “United chief Andrew Witty was 2023’s highest-paid CEO. Here’s what his peers earned,” May 20, Fierce Health Care, www.fiercehealthcare.com
“Most profitable industries in the U.S. in 2024 (2024) IBISWorld, www.ibisworld.com
“New research: Insured, working-age Americans face widespread medical billing errors; coverage denials for doctor-recommended care,” (2024) August 1, Commonwealth Fund
www.commonwealthfund.com
Rucker, F. (2023) “How Cigna saves millions by having its doctors reject claims without reading them,” March 25, ProPublica, www.propublica.com
Siddiqi, S. (2024) “U.S. Senate subcommittee raises alarms over Medicare Advantage’s denial of post-acute care,” December 17, Skilled Nursing News, www.skillednursingnews.com
Stannard, E. (2024) “Health insurance CEOs rake in millions: Here’s the top 10 list,” March 2024, Hartford Courant, MedicalXpress, www.medicalexpress.com
Whoriskey, P, (2024) “Deny and delay: the practices fueling anger at U.S. health insurers,” December 16, The Washington Post, www.washingtonpost.com