UnitedHealthcare has the highest claim denial rates by insurance companies

UnitedHealthcare, whose CEO Brian Thompson was fatally shot in Manhattan on Wednesday, has faced mounting scrutiny in recent years over its high rate of claim denials.

While the motive for the attack is still under investigation, NYPD officials have described the shooting as “targeted” and “premeditated.” According to the Associated Press, investigators discovered messages on the gunman’s ammunition—“deny,” “defend,” and “depose”—which appear to reference strategies often associated with the insurance industry’s approach to handling claims.

In 2023, UnitedHealthcare denied about one in three claims, the highest rate among major insurers and double the industry average of 16%, according to an analysis by ValuePenguin, a consumer research site specializing in insurance. The findings were based on in-network claims data from the Centers for Medicare & Medicaid Services.

“UnitedHealthcare has always been close to the top” in terms of claim denial rates, said Divya Sangameshwar, an insurance expert at ValuePenguin. “You see a lot of these anguished messages [from patients] all over.”

Complexity and Criticism

The reasons behind claim denials are often complex and difficult for consumers to understand, Sangameshwar explained. In many cases, a doctor may recommend treatment, but the insurer determines that it falls outside the policy’s coverage and refuses to pay.

UnitedHealthcare has been repeatedly criticized for its practices. A Senate report previously called out health insurers, including UnitedHealthcare, for denying care to elderly patients who had suffered falls or strokes.

“My heart goes out to people who have a medical issue and find out their health insurance is inadequate,” Sangameshwar added.

The company’s practices, now under fresh public scrutiny, highlight broader concerns about the healthcare insurance industry’s approach to coverage and claims.