In the United States, a growing number of patients find themselves at the mercy of a healthcare system that prioritizes profit over care. Sarah, a breast cancer survivor and current patient, represents the countless others who have been put through the ringer by her insurance company, UnitedHealthcare. When her life-saving chemotherapy regimen is $17,000 a month, treatment delays have made Sarah feel that her situation is hopeless. She thinks a lot of folks are “just throwing in the towel” for the same reasons.
The U.S. is alone among developed countries not to provide universal healthcare coverage. This lack leaves millions of people exposed to crippling amounts of medical debt. In truth, the burden of medical debt is one of the greatest drivers of personal bankruptcy nationwide. About one in six adults have debts related to health care more than $1,000. At the same time, a full one percent of the US population has more than $10,000 in medical bills.
UnitedHealthcare has a deservedly controversial reputation for denying claims. In 2024, a Senate committee investigated the Medicare Advantage scheme and spotlighted UnitedHealthcare as one of three companies accused of intentionally denying claims to boost profits. This cycle of denial has sparked outrage and serious alarm among advocates and healthcare professionals as well.
Yet UnitedHealthcare’s chief executive, Brian Thompson, took home more than $10 million this year. His recent assassination in December 2024 is raising the public outcry and escalation against the insurance industry ever further. According to police, alleged gunman Luigi Mangione was charged with Thompson’s murder and it was “premeditated, cold-blooded,” they said. Specifically, bullet casings located at the site of the crime were marked with the phrase “deny, defend, depose.”
We got a chance to talk with Nathalie Collins, a former employee of the medical claims department at UnitedHealthcare, about her experience. She handled as many as 180 calls a day and detailed a disturbing culture of denial at the company.
“We had coaching to be able to deny it [medical claims] … we would have scripts on screen explaining what to say to get them [customers] off the call, or maybe satisfy them.” – Nathalie Collins
Collins shared alarming stories about the potentially life threatening impact of treatments held up due to insurance denials. Most importantly, she stressed that patients are harmed tremendously when they are prevented from accessing the appropriate care in a timely fashion.
“In some situations, losing limbs, losing body parts because they didn’t get treatment in time … I should not be able to hit a button and make such a determination on someone’s life.” – Nathalie Collins
Dr. Elizabeth Potter, an incredibly thoughtful and committed healthcare provider and advocate, didn’t pull any punches in her disdain and anger towards insurance. She added, “It’s like we’re exposing a fraudulent operation. She pointed out that patients pay into the system for decades. Yet, they regularly find themselves disappointed when they need care the most.
“We’ve been paying into a system that isn’t there when we need it.” – Dr. Elizabeth Potter
Insurance companies’ challenges go far past the personal level. Steven Cohen is a New York attorney who focuses on class action suits against private corporations. He shared how these companies focus on driving profits for shareholders, rather than realigning care to improve patient health.
“Insurance companies are private companies that are responsible for their shareholders, not to their members who get the insurance but to their shareholders to maximize profits.” – Steven Cohen
The shifting sands of the current landscape have created much confusion regarding what insurers must do and what patients can expect. In the meantime, millions are forced to wait for life-saving breakthroughs as they try to maneuver through a system created to shield corporate profit margins.
Health practitioners are coming to the conclusion that these systemic obstacles are closing the door on very outcomes. As Dr. Potter reminded us, when patients experience delays in diagnosis and treatment, they may face life-threatening consequences.
“Maybe the condition will go away. Maybe some cheaper tests emerge … Too often, people die as a result of a delay of diagnosis and treatment.” – Luigi Mangione
Against the backdrop of these hardships, Sarah’s fight with cancer puts a personal face on the issue of medical debt and insurance denials. Along with her mother, she is constantly fighting for her life each day. Yet, every day, she faces obstacles that threaten both her well-being and economic security.
UnitedHealthcare has responded to allegations of denial by the margins to avoid, claiming that it doesn’t practice blanket denial. During the American Well presentation, the company explained that it pre-authorizes and pays about 90 percent of medical claims at the time of departure. However, many patients feel sidelined by bureaucratic processes that complicate access to necessary care.
“Highly inaccurate and grossly misleading information has been circulated about our company’s treatment of insurance claims,” – UnitedHealth Group
The reality is different and many are left without a home, despite these assurances. The high stakes of medical treatments render actual patients vulnerable to corporate monopolies that decide what kinds of care they receive.
