Investor group wants UnitedHealth Group study on health insurance claims denials, prior authorization rules

The company said there’s been widespread misinformation about the denial rate at UnitedHealthcare, which is the nation’s largest health insurer. About 90% of medical claims are paid upon submission, the company says, while a small fraction of those requiring further review are due to medical or clinical reasons.

Bạn đang xem: Investor group wants UnitedHealth Group study on health insurance claims denials, prior authorization rules

Xem thêm : Why new homes could be affordable solution to insurance costs

“Health care is both intensely personal and very complicated, and the reasons behind coverage decisions are not well understood,” Witty wrote in the guest column. “We share some of the responsibility for that. Together with employers, governments and others who pay for care, we need to improve how we explain what insurance covers and how decisions are made.”

The shareholder proposal argues that by requiring prior authorizations and denying patient care, UnitedHealthcare could boost short-term revenue but risk the company’s brand and pushing consumers into debt. It cited a U.S. subcommittee report that found higher denial rates by UnitedHealthcare and two other national insurers for Medicare patients seeking post-acute care — the company says the government requires health plans to give these claims more scrutiny.

Xem thêm : Are the Dems or the GOP Better for My Insurance Premiums?

A class-action lawsuit in 2023 alleged UnitedHealth Group was using a faulty artificial intelligence algorithm to wrongly deny coverage for Medicare patients who need rehabilitation care following hospitalizations. The complaint in the U.S. District Court of Minnesota came as the health news website STAT published an investigation into the company’s use of the technology.

UnitedHealth Group promised a vigorous defense against the lawsuit, claiming it had no merit. The technology was not used for coverage determinations, the company said, but instead “is used as a guide to help us inform providers, families and other caregivers about what sort of assistance and care the patient may need both in the facility and after returning home.”

In July, the Wall Street Journal published an investigation alleging UnitedHealthcare and other private insurers in the government’s Medicare Advantage program made hundreds of thousands of questionable diagnoses that triggered an extra $50 billion in taxpayer-funded payments.