UnitedHealth Group, the largest health insurer in the U.S., is facing growing criticism over care denials, rising costs, and a system that many patients find confusing. In response, the new CEO has made a public commitment to improve communication with patients and make access to care easier.
This change comes after months of scrutiny, particularly following the tragic death of former CEO Brian Thompson, who was shot while heading to an investor meeting in December. This incident sparked a significant backlash on social media and highlighted a disconnect between the company’s self-image and public perception.
In interviews from March, UnitedHealth executives recognized that many consumers feel overwhelmed by the healthcare system. They expressed concern about delays caused by prior authorizations and coverage denials, which frustrate patients seeking care. Tim Noel, who has taken over Thompson’s role, stated, “We are fixing them,” acknowledging the ongoing challenges the company faces.
To address these issues, UnitedHealth has started reducing the number of medical services that require prior approval. Specifically, for Medicare, the company has cut prior authorization requirements by 40% since 2016. They are also developing tools to help doctors and patients check insurance coverage and get cost estimates directly during appointments.
These efforts are part of a broader shift in UnitedHealth’s business model. The company is moving from a focus on employer-sponsored insurance to providing more direct care through its Optum Health unit, which now serves nearly five million patients with Medicare-like plans.
However, challenges persist, especially in the Medicare Advantage market, which makes up 40% of UnitedHealth’s revenue. During a recent Senate confirmation hearing, CMS nominee Mehmet Oz raised questions about how insurers like UnitedHealth use in-home visits to evaluate patient needs, a practice that can affect federal reimbursements.
UnitedHealth defended these visits, stating they help identify mental health risks and unsafe living conditions. Optum CEO Heather Cianfrocco emphasized that this approach allows healthcare providers to gain insights into patients’ situations and share findings with their primary doctors.
Despite these assurances, some experts remain skeptical. Sabrina Corlette from Georgetown University noted that consumers today face higher out-of-pocket costs than they did a decade ago, leading to increased dissatisfaction.
Facing these pressures, Noel and other leaders at UnitedHealth are determined to simplify care and enhance transparency. Chief Financial Officer John Rex highlighted the goal of improving health outcomes and creating a more affordable healthcare system, saying, “If you’re able to do that, that’s something that everyone can coalesce around.”