Dr. Emrick's Books, Blogs, and Podcasts
United Healthcare: Profit over Patients?
Imagine, for a moment, that you are in a hospital waiting
room, where the smell of antiseptic and stale coffee is a familiar scent as you
sit, clutching a folder stuffed with medical bills and denial letters from
UnitedHealthcare. At 42, you are a single mother of two, a part-time librarian
in Omaha, Nebraska, battling Stage III breast cancer. Your oncologist had
recommended a specialized radiation therapy to shrink the tumor before surgery,
but UnitedHealthcare had denied the claim three times, citing “insufficient
evidence of medical necessity.” Each denial arrived in a crisp envelope, the
words cold and clinical, as if your life were a spreadsheet entry. This is a
daily reality for many.
Across the country, in a small apartment in Raleigh, North
Carolina, James sat at his kitchen table, staring at a similar stack of
letters. A 35-year-old mechanic with Type 1 diabetes, James, has been fighting
for coverage of a new insulin pump that could better regulate his blood sugar.
UnitedHealthcare’s response was always the same: “Not covered under your plan.”
The pump cost $7,000 out of pocket, more than Jame’s savings after a year of
car repairs slowed by his worsening health. He’d appealed twice, spending hours
on hold, navigating automated menus, and repeating his story to representatives
who sounded more like gatekeepers than helpers. Each call ended with a promise
of “further review,” but the denials continued, leaving James to ration his
insulin and pray he’d avoid another ER visit.
Don’t worry, you're not alone. In 2024, UnitedHealthcare
faced a firestorm of criticism for its high claim denial rates, with reports
estimating that the insurer rejected about one-third of claims, which is double
the industry average. Social media buzzed with stories of denied care—X posts
detailed everything from rejected cancer scans to refused mental health
treatments. One user, a surgeon, shared a letter from UnitedHealthcare denying
emergency care for a patient with pulmonary embolisms, writing, “This is a
woman who was in the ER fighting for her life.” Another post from a former
employee alleged the company pressured staff to meet denial quotas. This claim
sent shockwaves through online communities as your fight began in early 2024,
when your doctor submitted a prior authorization request for radiation therapy.
The process was supposed to take a week, but two weeks later, UnitedHealthcare
denied it, claiming the treatment was “experimental.” Your oncologist, Dr. Jones,
was livid. “This is standard care for your condition.” Dr. Jones told me, “I’ve
seen this too many times with United.” You appeal the denial, gathering medical
records, letters from specialists, and studies proving the therapy’s efficacy.
The appeal process was a labyrinth filled with forms to complete, deadlines to
meet, and a 60-day wait for a response. When the second denial came, you broke down
in your car, terrified you would run out of time.
James' struggle was no less grueling. His endocrinologist had warned that without the pump, his blood sugar swings could lead to kidney damage or worse. After the first denial, James called UnitedHealthcare, spending 90 minutes on hold before speaking to a representative who suggested he “try a less expensive model” that didn’t exist for his needs. The second denial cited a “lack of prior authorization,” though his doctor had submitted the paperwork months earlier. James's appeals felt like shouting into a void. He started a GoFundMe to cover the cost of the pump, but the $1,200 raised was a mere drop in the bucket. At night, he lay awake, calculating the cost of survival. The tipping point for public outrage came in December 2024, when UnitedHealthcare’s CEO, Brian Thompson, was fatally shot in Manhattan. Bullet casings at the scene bore the words “deny,” “delay,” and “depose,” fueling speculation that the attack was linked to the company’s practices. While police found no evidence that the shooter was a UnitedHealthcare customer, the incident unleashed a torrent of patient stories. A Reuters report noted that claim denials had risen 31% from 2022 to 2024. In 2022, UnitedHealthcare denied 8.7% of prior authorization requests for Medicare Advantage plans, compared to 4.2% for some competitors. A KFF survey revealed that only 10% of patients appealed denials, and among those who did, a third still failed to obtain coverage.
One woman described paying $1,000 out of pocket for dental
work that UnitedHealthcare refused to cover; another recounted a rejected MRI
that delayed her stroke diagnosis. Another posted her own story, writing, “I’m fighting
for my life, and they’re fighting to save a buck.” The group became her
lifeline, a place where she could vent and strategize her approach. She learned
about filing complaints with her state’s insurance department, a step that
finally prompted UnitedHealthcare to reconsider her case. In January 2025,
after months of delays, the radiation therapy was approved, but the tumor had
grown, and her prognosis worsened. A breaking point came when James landed in
the hospital after a diabetic crisis in February 2025. The ER bill was $12,000,
and UnitedHealthcare covered only a fraction, citing “out-of-network”
providers, though James had no choice in the emergency. Furious, he contacted a
lawyer who specialized in insurance disputes. The lawyer warned that federal
laws limited damages for denied claims, making lawsuits a long shot. Still, James
joined a class-action suit alleging UnitedHealthcare used faulty AI algorithms
to deny claims, a practice a Senate report had flagged in October 2024. The
report revealed that denial rates for post-acute care in Medicare Advantage
plans had increased to 22.7% in 2022, up from 10.9% in 2020, often due to
automated systems with an error rate of 90%.
UnitedHealthcare responded to the backlash with statements
claiming it approved 90% of claims upon submission, with only 0.5% of denials
due to medical reasons. The company called reports of high denial rates
“grossly misleading” and emphasized its mission to deliver quality care. But
patients like Sarah and James saw little evidence of that mission. While Sarah's
radiation therapy was underway, the delays had cost her precious time, and she
faced mounting debt from co-pays and uncovered tests. James' hospital stay
pushed him to take a second job, despite his fragile health, to cover bills.
Both felt betrayed by a system they’d paid into, expecting protection, not
obstruction.
As spring 2025 unfolded, the public’s anger simmered.
Protests erupted outside UnitedHealthcare’s headquarters, and hospitals,
including Oregon Health & Science University, threatened to drop the
insurer over denial rates as high as 56.4%, far above the industry’s standard
of 5-10%. Sara and James, no strangers to UnitedHealthcare, shared a struggle,
followed the news with weary hope. They didn’t want revenge; they wanted
reform. Sarah dreamed of a day when no one would beg for care they’d already
paid for. James just wanted to live without fear of the following letter. For
now, they carried on, their stories part of a growing chorus demanding a
healthcare system that values life over ledgers.
Profits over Patients
UnitedHealth Group's net income plummeted from $22.3 billion
in 2023 to $14.4 billion in 2024, a 35.6% decline, driven by a $3.1 billion
cyberattack on its Change Healthcare subsidiary and soaring medical costs. The February
2024 ransomware attack disrupted billing and claims processing, incurring
response costs and financial aid to affected providers. Rising healthcare
utilization, especially in Medicare Advantage plans, pushed the medical loss
ratio to 85%, with elective procedures and drug price inflation straining
margins. Regulatory scrutiny over high claim denial rates (32%, double the
industry average) and lawsuits alleging improper AI-driven denials added costs.
The murder of CEO Brian Thompson in December 2024 fueled negative publicity,
while operational expenses outpaced 11.2% revenue growth. Despite cost-cutting
efforts, these challenges slashed net margins from 6.0% to 3.5%, reflecting a
turbulent year for UnitedHealthcare’s parent company amid industry-wide
pressures and public backlash over denied care. On May 13, 2025, UnitedHealth
Group announced that CEO Andrew Witty stepped down abruptly for "personal
reasons," with Stephen Hemsley, the company’s chairman and former CEO from
2006 to 2017, taking over immediately. Witty’s exit coincided with UnitedHealth's
suspension of its 2025 financial outlook due to surging medical costs,
particularly in Medicare Advantage plans, where new enrollees drove expenses
higher than anticipated. The company’s stock plummeted nearly 18%, hitting a
four-year low, reflecting investor alarm over financial struggles and
leadership upheaval.
Witty’s four-year tenure saw revenue soar to $400 billion, a
55% increase, but 2024 was brutal: a $3.1 billion Change Healthcare
cyberattack, the murder of UnitedHealthcare CEO Brian Thompson, and scrutiny
over high claim denials (32%, double the industry average) battered the
company. Posts on X speculated Witty was "pushed out" amid a DOJ
probe into alleged Medicare fraud, though UnitedHealth cited personal reasons.
Hemsley apologized for "performance setbacks," aiming for 13–16% growth
by 2026. More to come!
So, what's next?
Comments
Post a Comment