UnitedHealthcare denies the most claims of any major health insurer, data show

UnitedHealthcare has faced criticism from patients for claim denials.Stephen Maturen/Photographer: Stephen Maturen/Ge

UnitedHealthcare, whose chief executive Brian Thompson was gunned down in Manhattan Wednesday, has come under scrutiny for its high rate of claim denials in recent years.

While the motive for the shooting remains under investigation, NYPD officials say the attack was “targeted” and “premeditated.” The Associated Press reported that law enforcement found messages on the ammunition the gunman used — “deny,” “defend,” and “depose” — which may be referring to tactics the insurance industry uses to avoid paying claims.

The company dismissed about one in every three claims in 2023 — the most of any major insurer. That’s twice the industry average of 16 percent, according to data from ValuePenguin, a consumer research site owned by LendingTree that specializes in insurance. The group’s analysis is based on in-network claims data from the Centers for Medicare & Medicaid Services.

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

The reasons for denying an insurance claim are often complicated and cryptic to consumers, Sangameshwar added. In a lot of cases, doctors can recommend treatment for patients, but the insurer can determine that the treatment falls outside its coverage area and refuse to pay.

UnitedHealthcare has long drawn scrutiny for rejecting claims. A Senate panel slammed health insurers for refusing to cover care for elderly people who have suffered falls or strokes. UnitedHealthcare featured prominently in that report.

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

Material from the Associated Press was used in this report.