The tragic murder of a prominent health insurance executive in Manhattan has sparked a wave of public outrage on social media, reflecting the deep-seated frustration many Americans feel towards the labyrinthine health insurance sector. A poignant instance of this backlash was the overwhelming response to a Facebook post by UnitedHealth Group, which mourned the loss of its CEO, Brian Thompson.

The post garnered 62,000 reactions, with a staggering 57,000 being laughing emojis—a testament to the public's discontent. UnitedHealth Group, the parent company of UnitedHealthcare, which Thompson led, is still grappling with the aftermath of the incident. The New York police are yet to uncover the shooter's identity and motive, but in an interview with NBC, Thompson's widow, Paulette, hinted at potential threats against her husband, possibly linked to "inadequate coverage... I'm not privy to the specifics."

An unnamed source also mentioned concerning threats against UnitedHealth Group, though Thompson was not specifically named. Law enforcement has found shell casings from the crime scene inscribed with the words "depose" and "delay," leading investigators to consider whether these words hint at a motive,think of a book that criticizes the entire insurance industry - 'Delay Deny Defend'.

According to a survey by KFF, a non-profit health policy research organization, released in June 2023, the majority of insured US adults faced at least one issue, such as claim denials, with their health insurance within a year. "Restrictions on care access due to claim denials have undoubtedly been a source of frustration for quite some time," remarked Kaye Pestaina, KFF’s director of the Program on Patient and Consumer Protections.

A major health insurance industry group rebuked some of the social media reactions, with Mike Tuffin, CEO of the trade association AHIP, stating, "Our industry professionals are dedicated to making coverage and care as affordable as possible and assisting individuals in navigating the complex medical landscape. We condemn any notion that threats against our colleagues—or any other citizens—are ever justified." UnitedHealthcare emphasized its commitment to supporting Thompson's family, ensuring employee safety, and collaborating with law enforcement to apprehend the perpetrator. "At UnitedHealth Group, we remain committed to those who rely on us for their healthcare needs," the company stated.

Following the news of Thompson's death, social media was inundated with users airing their grievances against UnitedHealthcare and other insurance firms. One user recounted their experience with UnitedHealthcare denying their surgery just two days before it was scheduled, leading to tears in the hospital finance office instead of pre-operative preparations.

The user's surgeon spent over a day advocating for the patient, who eventually underwent the surgery but described the ordeal as "torture." Another user shared their story of having breast cancer surgery denied by an insurance company, highlighting the callousness of the situation. Anesthesiologist and TikTok influencer Brian Schmutzler addressed the shooting in a video, acknowledging its tragedy while also pointing out the broader issues with insurance companies, whose primary duty is to generate profits rather than facilitate healthcare.

Journalist Taylor Lorenz, in a blog post titled "Why ‘we’ want insurance executives dead," analyzed the online responses, stating, "No, it doesn't mean people should murder them. However, if you've witnessed a loved one suffer or die due to insurance denial, it's understandable to wish the same upon those responsible." Lorenz's post sparked significant backlash.

It's common for Americans and their physicians to jump through hoops to secure approval for necessary care or to contest denials from insurers, even though 81% of insured adults in KFF's 2023 survey rated their health insurance as "excellent" or "good." Sara Collins, a senior scholar at The Commonwealth Fund, a health policy foundation, explained the distress caused by denials or delays, especially in critical cases like cancer diagnoses. "To have a decision suddenly based on financial considerations is extremely distressing for families," she said.

Nearly one in five insured adults experienced claim denials over a 12-month period, according to KFF's 2023 survey. Those with job-based insurance or Affordable Care Act policies faced this issue twice as often as those covered by Medicare or Medicaid, whose denial rates were approximately one in ten. Health insurers employ tactics like claim denials and prior authorization to filter out care that may not be medically necessary or scientifically supported, which can also boost their profit margins.

These practices, increasingly reliant on technology and artificial intelligence, can infuriate both patients and providers. A class action lawsuit filed last year in US District Court in Minnesota claimed that UnitedHealthcare used AI "instead of real medical professionals to wrongfully deny elderly patients care," as stated in the complaint. The suit alleges that over 90% of denials are overturned through internal appeals or federal administrative law judge proceedings.

The denial of claims can lead to significant problems for patients, affecting both their care and finances. Last year, UnitedHealthcare settled a case with a critically ill college student in Pennsylvania who alleged the company denied coverage for drugs deemed necessary by his doctors, resulting in a medical bill exceeding $800,000. The lawsuit, reported by ProPublica, revealed the extent to which the insurer goes to reject claims, including suppressing medical reports and relying on pre-approved recommendations from company-paid doctors.

Approximately a quarter of consumers whose claims were denied by insurance companies experienced significant delays in receiving medical care or treatment, and about the same proportion were unable to receive care at all, according to the KFF survey. About a quarter of those individuals reported a decline in their health. Postponing care due to coverage denials can also impact patients' mental health, with 80% of adults stating they or a family member were worried or anxious about care delays, as per a 2023 Commonwealth Fund survey of adults aged 19 to 64.

Relatively few people contest when their insurer denies their claim. Only 43% of adults in the Commonwealth Fund survey said they or their doctor challenged an insurer's denial of claim. Some 45% of respondents were unsure if they had the right to appeal the denial, while 40% were uncertain about whom to contact. Nearly a quarter cited a lack of time. However, challenging the denial can be effective, with half of those who appealed ultimately having their care approved, as found by the Commonwealth Fund survey.

Inappropriate denials of services and payments by Medicare Advantage insurers, including UnitedHealthcare, the largest player in the rapidly expanding market, have faced scrutiny in recent years, particularly from the Department of Health and Human Services, which oversees the program, and some lawmakers. Insurers, paid by the federal government to provide Medicare services to enrollees, have sometimes delayed or denied beneficiaries' access to medical care—even when requests complied with Medicare coverage rules, according to a 2022 report from the HHS inspector general's office. Annual federal audits have highlighted "widespread and persistent problems related to inappropriate denials of services and payment," the office stated.

A central concern is the potential incentive for Medicare Advantage plans to deny access to services and payments to providers in an attempt to increase profits, as insurers receive a fixed amount of money per patient regardless of the care received. UnitedHealthcare, in particular, has been under public scrutiny for significantly increasing care denials for its Medicare Advantage enrollees.

The insurer more than doubled the rate of denials for care following hospital stays between 2020 and 2022 as it implemented machine-assisted technology to automate the process, according to a Senate Permanent Subcommittee on Investigation’s report released in October. This increase far exceeded that of its competitors, including Humana, whose care denials grew by 54% during the same period. "Despite alarm and criticism in recent years about abuses and excesses, insurers have continued to deny care to vulnerable seniors—simply to make more money," Connecticut Sen. Richard Blumenthal, who chairs the subcommittee, stated in October.