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The murder of Brian Thompson was a heinous act. The CEO of UnitedHealthcare was essentially assassinated outside a New York City hotel last week. On Monday, police took into custody and were questioning a person of interest in connection with the shooting. The man, who was identified in Pennsylvania, was carrying a manifesto criticizing health care companies, a gun and a silencer, law enforcement officials said.
There is a lot we don’t know about the murder of Thompson. Law enforcement officials have said that bullet casings found at the scene of the shooting appear to be inscribed with “deny,” “defend,” “depose” — parlance that echoes phasing used by insurance companies to avoid paying health claims from patients.
However, it is far too early to know a motive for the killing.
What we do know is that Americans are increasingly struggling with America’s health care system and its rising costs. They, and lawmakers, are also frustrated with the role of insurance companies, which are increasingly denying coverage for some medical procedures. A poll earlier this year found that two-thirds of Americans say that health insurance companies deserve “a lot of the blame” for rising health care costs.
Denying or limiting coverage of care and procedures that have been requested by medical professionals is on the rise. In one example, Anthem Blue Cross Blue Shield had announced in November that it would no longer fully pay for anesthesia for some surgeries in some states. It pulled back that announcement on Thursday after its decision received scrutiny and criticism after Thompson’s killing.
Denials of coverage of tests and treatments requested by medical providers before they occur can prompt patients to delay and forgo needed care. Denials after the fact leave patients with unexpected medical bills.
UnitedHealthcare’s denial rate of nearly a third is twice the industry average of 16 percent. It was rated the worst for denials among large health insurers, by one assessment. UnitedHealthcare is the insurance wing of parent company UnitedHealth Group Inc., which pays for and manages health care.
None of this should amount to a death sentence for a top company executive. Thompson’s murder was horrific and the way some have celebrated it has been grotesque. We must be able to mourn the man while questioning the practices of the company he led and the industry he worked in. Those understandably calling for a more humane health care system should not discard others’ humanity in the process.
In an investigation last year, ProPublica found that one of the nation’s largest health insurance companies, Cigna, had built a system to quickly review (and often deny) some health care claims without actual assessment of the patient record by a medical professional. Instead, doctors employed by Cigna signed off on decisions made by the automated review system. Over a period of two months in 2022, Cigna doctors denied over 300,000 requests for payments using the system, spending an average of 1.2 seconds on each case, according to documents reviewed by ProPublica and The Capitol Forum.
Patients can appeal such rejections, but very few do.
One doctor calls such denials by insurance companies “a usurpation of my role as the expert clinician with deep, intimate knowledge of the patient.”
“It is patently ridiculous, even to the layperson, to think that an entity that has never met the patient and does not have sufficient training or experience to make a medical decision is more qualified than the patient’s doctor,” William Bennett, a pediatric gastroenterologist in Indiana, wrote in a journal article in 2020. “It is doubly curious that insurance companies rarely respond with a suggestion for what to do instead, only what we should not do,” he added.
Congress has repeatedly stepped in to criticize the high rates of denial and has launched investigations. Through passage of the Affordable Care Act, it even tasked the Department of Health and Human Services with tracking denials. But, lawmakers have not followed up with tougher requirements.
Insurance companies and their practices are only one piece of our complex and expensive health care system. But, with renewed scrutiny of insurance company denials, it is time for Congress to take a deep look and to develop steps toward better ways of protecting Americans from unnecessary and hard to justify denials of coverage for health care their doctors have prescribed.
