Murder of UnitedHealthcare executive fuels patients' anger over insurance By Reuters

By Stephanie Kelly and Julie Steenhuysen

NEW YORK (Reuters) -Jen Watson, a 41-year-old mother in Federal Way, Washington, has worked for years with her doctor to find the right medications to treat her multiple chronic illnesses, including epilepsy and fibromyalgia.

His doctor had found some medications that could reduce Watson's nerve pain, but Watson says his UnitedHealthcare Medicaid plan refused to cover the medications. And because of her pain, Watson has found it difficult to find work.

“I've been struggling to find work partly because I can't stand for more than 15 minutes and I end up in severe pain very quickly because my symptoms are not well controlled,” Watson told Reuters.

Last week's assassination of a powerful health insurance executive has sparked a wave of anger among Americans struggling to receive and pay for health care.

Police are still searching for the man suspected of killing UnitedHealthcare CEO Brian Thompson and have not determined a motive. But the attack drew attention to growing frustrations over health coverage.

Recent data shows that patients are now even more likely to have their claims denied, pay more for premiums and doctor visits, and face unexpected costs for care they thought was covered by their health plan. The increase in costs is attributed in part to the consolidation of doctors' offices, hospitals and insurers.

UnitedHealthcare, part of UnitedHealth Group (NYSE:), is the largest health benefits administrator, followed by Cigna (NYSE:) and CVS Health (NYSE:).

“It's a very shocking event. But it's also an opportunity for people to vent about issues that have been of great concern to many people,” said Tahneer Oksman, a professor in the communications department at Marymount Manhattan College in New York.

Americans pay more for health care than any other country, and over the past five years, spending on insurance premiums, out-of-pocket copays, pharmaceuticals and hospital services has increased, government data show.

UnitedHealth stock has nearly doubled over the past five years. During the week of the shooting, UnitedHealth shares fell more than 10% through Friday.

UnitedHealth, CVS and Cigna did not comment for this story.

Insurance industry trade group AHIP said in an emailed statement that health plans, providers and drug manufacturers share the responsibility of making care as affordable as possible and easier to navigate.

“Health plans are working to protect patients from the full impact of rising costs while connecting them to safe, evidence-based, and coordinated care,” the group said.

Insurers that administer health and drug benefits say they negotiate low prices for doctor visits, hospital stays and expensive medications. Most plans are sponsored by employers or government customers who foot part of the bill and have a say in what is covered.

Kevin Gade, chief operating officer of investment firm Bahl & Gaynor, which owns about 2.6% of UnitedHealth shares, said companies like UnitedHealth play an important role in providing critical and necessary care to all patients within an inefficient American healthcare system that needs to evolve.

“Unfortunately, when it comes to people's lives, there is the reality that there will be setbacks along the way,” he said.

Justine, 51, a UnitedHealthcare client who works at a nonprofit in New York City, was diagnosed with breast cancer in 2017 and underwent a double mastectomy in 2018. She asked that her last name be withheld because privacy reasons.

A year after surgery, she developed lymphedema, in which fluid builds up in the arm that can cause infections, and is treated by fitting custom-made compression sleeves.

Her employer's insurance, UnitedHealthcare, approved the covers, which cost $4,000 for a night cover and several hundred dollars for a day cover that were replaced every three to four months.

But the company that made them said UnitedHealthcare didn't pay, citing several paperwork problems. “That went on for a long time,” Justine said. “I kept thinking, is this a time-running situation?”

The Patient Advocate Foundation, a charity that provides financial and claims help for patients, has found that cases have become much more difficult to resolve.

In 2018, a case manager would need to initiate an average of 16 phone calls or emails to resolve a claim; now there are 27, said Caitlin Donovan, a spokeswoman for the group.

“The American health insurance industry is becoming more complicated to navigate, negotiate and attempt to appeal,” Donovan said.

DENIALS OF CLAIMS INCREASE

The Affordable Care Act of 2010, commonly known as Obamacare, laid new groundwork for who and what insurance plans should cover. As costs rose, insurers increasingly turned to the prior authorization process, vetting requests for medical services before agreeing to pay.

Prior authorizations were implemented 46 million times in 2022, up from 37 million in 2019, according to a KFF analysis of privately managed Medicare Advantage plans for people 65 and older or disabled. CVS denied 13% of those requests, while Elevance's Anthem Blue Cross Blue Shield denied 4.2%. UnitedHealthcare denied 8.7%.

Only about 10% of patients appeal these denials, and of those challenges, about a third fail, KFF said.

in an american Doctor (TASE:) In the Association's 2023 survey, 94% of doctors said prior authorization delayed care and 78% said it sometimes led patients to abandon treatment. Nearly 1 in 4 reported that it had resulted in a serious adverse event for patients and 95% reported that it increased physician burnout.

Health claim denials also increased, rising 31% in 2024 over 2022, according to a 2024 survey by credit firm Experian (OTC:) of 210 healthcare staff members responsible for billing and payment. refund.

Patients who are denied claim appeals have few avenues for legal redress beyond the insurer's own process. The federal law for employer-sponsored plans limits damages to the amount of a denied claim, which means few law firms are willing to take these types of cases, said Sara Haviva Mark, an attorney who specializes in representing people whose claims are denied.

In the KFF survey, 18% said their health plans did not pay for care they thought was covered in the previous 12 months.

Rachel Benzoni, a 37-year-old doctoral student in Omaha, Nebraska, said she has seen loved ones and friends struggle to navigate the health care system and has had trouble receiving UnitedHealthcare coverage for routine procedures, including care dental.

“I recently paid almost $1,000 to have periodontal work done, as United denied my entire claim,” he said, adding that they did not give a reason for the denial beyond the fact that the procedure was not covered.