Why we can’t VERIFY a chart showing UnitedHealthcare denies more claims than other insurers

UnitedHealthcare CEO Brian Thompson was gunned down outside of a Manhattan hotel on Wednesday, Dec. 4. Luigi Mangione, 26, has since been arrested and charged in the killing.

In the days after Thompson’s death, UnitedHealthcare came under fire on social media over its alleged high rate of health insurance claim denials.

A chart shared in many viral posts across social media shows claim denial rates for major insurance companies. UnitedHealthcare’s denial rate is highest at 32%, according to the posts. 

VERIFY investigated available data to determine whether the viral chart is accurate.

THE QUESTION

Does UnitedHealthcare deny patients’ claims at the highest rate of any major insurer, like the viral chart claims?

THE SOURCES

• The Affordable Care Act (ACA)
• ProPublica investigation on health insurers’ denial rates published in June 2023
• ValuePenguin, a consumer research site owned by LendingTree
• VERIFY analysis of available data from the Centers for Medicare and Medicaid Services
• Article published by KFF, a nonprofit healthy policy research organization, in May 2023

THE ANSWER

The claim that UnitedHealthcare denies patients’ claims at the highest rate of any major insurer is inconclusive. The federal government and private health insurers don’t make data on claim denials for all types of insurance plans available to the public. 

WHAT WE FOUND

We can’t VERIFY that UnitedHealthcare denies claims at the highest rate of any major health insurer. 

That’s because the federal government and private health insurers, like UnitedHealthcare, don’t make data on claim denials for all types of insurance plans available to the public. 

Former President Barack Obama signed a comprehensive health care reform law called The Affordable Care Act (ACA), which is also known as Obamacare, into law in 2010. 

That law tasked the federal government’s Department of Health and Human Services with “monitoring denials both by health plans on the Obamacare marketplace and those offered through employers and insurers,” Elisabeth Rosenthal reported for KFF Health News, which is part of the nonprofit health policy research and news organization KFF, in May 2023. 

But HHS “hasn’t fulfilled that assignment,” Rosenthal said. 

Data the federal government has collected and shared so far isn’t comprehensive and it isn’t audited to ensure it’s accurate, a ProPublica investigation and KFF found. 

VERIFY reviewed the ACA and found it also tasked the head of the Government Accountability Office (GAO) with conducting a “study on the incidence of denials of coverage for medical services and denials of applications to enroll in health insurance plans.” That GAO report was published in March 2011 but it doesn’t break down denial rates by individual insurers. 

Where the data in the viral chart comes from

VERIFY traced the viral chart back to an article published by ValuePenguin, a consumer research website owned by LendingTree, in May 2024. 

ValuePenguin has since removed the chart from its article, though the alleged denial rates are still included in the article. The website said on Dec. 6 that it “removed certain data elements” from the piece “at the request of law enforcement.”

The chart published by ValuePenguin, which is shown in an archived version of the article here, alleges that UnitedHealthcare denies nearly one-third of claims it receives – or 32% to be exact – the highest rate of any major insurer. It’s followed by Medica at 27% and Anthem at 23%.

These rates were based on available data on insurers’ claim denials and appeals from the Centers for Medicare and Medicaid Services’ (CMS) public use files, which are available online, ValuePenguin said. ValuePenguin says the CMS data the website used is from the calendar year 2022 and doesn’t include any other years. Medicare and Medicaid data doesn’t include information about employer-sponsored private health plans, which cover the majority of working-age Americans. 

VERIFY conducted our own analysis of the most recent data from CMS comparing the total number of the in-network claims that health insurers received to their in-network denials. We did not factor in appeals. 

Our analysis found that UnitedHealthcare did deny claims at a rate of around 33% – the highest rate of any major insurer. This closely mirrors what ValuePenguin found.

But there are a handful of caveats to the CMS data that make it impossible to draw conclusions about how often health insurers actually deny patients’ claims. 

Why it’s impossible to know exactly how many claims health insurers deny

The data-gathering on health insurers’ denials is “haphazard and limited to a small subset of plans,” and it “isn’t audited to ensure it is complete,” Karen Pollitz, a retired senior fellow at KFF, said in the 2023 KFF Health News article.

When it comes to information that the federal government has collected, it is not standardized or audited, and therefore is “not really meaningful,” Peter Lee, the founding executive director of California’s state marketplace, also told ProPublica. Data “should be actionable” and “this is not by any means right now,” he added.

VERIFY reached out to CMS and UnitedHealthcare for comment, but did not receive responses by the time of publication.