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UnitedHealthcare (UNH-5.22%) is dealing with increasing examination for its presumably high claim rejection rate. Because insurance providers attempt to keep these numbers concealed, the real level of its rejections stays unsure, specifically when it comes to personal strategies.
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The increased analysis comes as the business's CEO Brian Thompson was fatally shot in New York City on Wednesday early morning, simply hours before he was set to speak at the health care company's yearly financier day.
Several outlets reported on Thursday that shell cases from the shooting had the words “reject,” “safeguard,” and “depose” composed on them. Some have actually hypothesized that these words describe terms market critics utilize to explain methods that insurance companies utilize to reject claims.
At the very same time, posts on social networks have actually been declaring that UnitedHealthcare's claim rejection rate is the greatest in the market at 32%. This figure originates from the individual financing site Value Penguin, which stated it computed that rate from offered in-network information from strategies offered on the market.
UnitedHealthcare did not right away react to an ask for remark from Quartz. UnitedHealthcare is a department of UnitedHealth Group and the biggest personal health insurance provider in the U.S. with a market cap north of $500 billion. Its most significant service, UnitedHealthcare Employer and Individual, serves more than 29 million Americans through health advantage strategies.
The Affordable Care Act allows regulators to need insurance companies to share info on claim rejections, the federal government has so far not gathered much of this information and has actually shared even less with the public, according to a 2023 report from ProPublica.
Still, some current reports reveal that rejections have actually been on the increase.
In October, a report from the U.S. Senate Permanent Subcommittee on Investigations revealed that the country's insurance companies have actually been utilizing AI-powered tools to reject some claims from holders of Medicare Advantage strategies.
The report discovered that UnitedHealthcare's rejection rate for post-acute care– healthcare required to shift individuals out of health centers and back into their homes– for individuals on Medicare Advantage strategies increased to 22.7% in 2022, from 10.9% in 2020.
In August, a report from the health policy research study non-profit KFF discovered that all Medical Advantage insurance companies totally or partly rejected 7.4% of previous permission demands– ask for protection of particular medical services– in 2022, up from 5.4% in 2019.
