Within minutes of UnitedHealthcare’s chief executive Brian Thompson being shot dead in the heart of Manhattan, the internet was flooded with anecdotes of how patients had been denied coverage by their insurers.
Instead of shock at Mr Thompson's killing, a torrent of hate was unleashed on the industry as public anger at the profit-hungry healthcare model in the US has once again been laid bare. A new twist on the decades-long battle over health care are allegations that insurers are using artificial intelligence to deny claims on mass.
Despite spending more than $4 trillion annually on health care – a per capita rate about twice as much as other industrialised nations – the US does not guarantee life-long coverage for all of its citizens and most Americans must turn to the complicated private health insurance market, which has the denial of claims built into its business model.
Much of the fury was aimed at UnitedHealthcare, the insurance giant that provides cover for more than 49 million Americans. It took in $281 billion in premiums last year.
The suspect in Mr Thompson's murder, identified as Luigi Mangione, 26, was arrested in Pennsylvania on Tuesday.
In July, 11 people were arrested after protesters took to the streets outside UnitedHealthcare's headquarters at Minnetonka, Minnesota. Demonstrators accused UnitedHealthcare of operating “a systemic practice of refusing to approve care through prior authorisation denials or pay for care through claim denials".
The company did not help its cause when Andrew Witty, the British chief executive of UnitedHealth, UnitedHealthcare’s parent company, condemned the public response after Mr Thompson's death.
“Our role is a critical role, and we make sure that care is safe, appropriate and is delivered when people need it,” Mr Witty said in a leaked video. “And we guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable.”
This only increased the public anger. Kaylan, a mother from Texas, published an appeal letter to United after her daughter was denied anti-emetics to help cope with the nausea caused by her chemotherapy drugs.
“Obviously you know better about the side-effects of chemotherapy than me, my peers and the entire scientific community,” she wrote.
Other health insurers are accused of similar behaviour. A woman in Wisconsin faced a $52,000 bill after she was taken to an “out-of-network” hospital after suffering a heart attack, rather than the one in network three blocks further down the road.
A mother was told to spend $6,000 on insulin – money she neither hard nor could raise – because the 90-day supply for her son was spoiled when the family fridge failed.
Matthew Claassen, a veteran insurance broker, was withering in his condemnation.
“Insurance companies have started practising medicine by defining what the medical professional can and cannot do,” he said on X. “They are not saving money for the consumer. They are generating an income for themselves by denying the consumer the care they expect because the insurance company will not pay the medical professional who should make those decisions.”
The centre of Mr Claassen’s complaint is the growing use of artificial intelligence to decide on claims, which should be vetted by medical professionals. In some cases, the handling of claims is outsourced, creating what cynics call a flourishing “dollars for denials” industry.
Cigna, another health insurance giant, which is being sued in California in a class action, rejected 18 per cent of its claims because it was allegedly using an AI algorithm to process claims.
According to the writ, it was this algorithm that enabled the company’s doctors to “automatically deny payments in batches of hundreds or thousands at a time”.
Cigna, which is contesting the case, said it used AI to “help expedite patient reimbursement.”
Another point of contention is insurers questioning treatment on the grounds of medical necessity, Caitlin Donovan of the Patient Advocate Foundation told The National.
“We are seeing an uptick in medical necessity being used to deny a claim,” she said. “What I can tell you is that there's an incredible amount of frustration and a sense of unfairness among the people we talk to, both professionally and anecdotally, because they feel like they're paying for insurance and not receiving it.
“It is becoming harder to navigate, even for our professional case managers. How long it takes us to resolve a case and how long how many different calls we have to make on behalf of our clients has gone up.”
Insurers have even questioned the use of an air ambulance for emergency treatment for a child.
It is not only patients who are unhappy. Hospitals are haggling with insurers and have been holding seminars to explore ways to counteract skyrocketing denials.
President-elect Donald Trump has enlisted TV personality Dr Oz and Robert F Kennedy to shake up American health care. They face a challenge.
UAE currency: the story behind the money in your pockets
The five pillars of Islam
1. Fasting
2. Prayer
3. Hajj
4. Shahada
5. Zakat
Sole survivors
- Cecelia Crocker was on board Northwest Airlines Flight 255 in 1987 when it crashed in Detroit, killing 154 people, including her parents and brother. The plane had hit a light pole on take off
- George Lamson Jr, from Minnesota, was on a Galaxy Airlines flight that crashed in Reno in 1985, killing 68 people. His entire seat was launched out of the plane
- Bahia Bakari, then 12, survived when a Yemenia Airways flight crashed near the Comoros in 2009, killing 152. She was found clinging to wreckage after floating in the ocean for 13 hours.
- Jim Polehinke was the co-pilot and sole survivor of a 2006 Comair flight that crashed in Lexington, Kentucky, killing 49.
Abu Dhabi racecard
5pm: Maiden (Purebred Arabians); Dh80,000; 1,400m.
5.30pm: Maiden (PA); Dh80,00; 1,400m.
6pm: Sheikh Zayed bin Sultan Al Nahyan National Day Cup (PA); Group 3; Dh500,000; 1,600m.
6.30pm: Sheikh Zayed bin Sultan Al Nahyan National Day Cup (Thoroughbred); Listed; Dh380,000; 1,600m
7pm: Wathba Stallions Cup for Private Owners Handicap (PA); Dh70,000; 1,400m.
7.30pm: Handicap (PA); Dh80,000; 1,600m
Who was Alfred Nobel?
The Nobel Prize was created by wealthy Swedish chemist and entrepreneur Alfred Nobel.
- In his will he dictated that the bulk of his estate should be used to fund "prizes to those who, during the preceding year, have conferred the greatest benefit to humankind".
- Nobel is best known as the inventor of dynamite, but also wrote poetry and drama and could speak Russian, French, English and German by the age of 17. The five original prize categories reflect the interests closest to his heart.
- Nobel died in 1896 but it took until 1901, following a legal battle over his will, before the first prizes were awarded.
If you go:
The flights: Etihad, Emirates, British Airways and Virgin all fly from the UAE to London from Dh2,700 return, including taxes
The tours: The Tour for Muggles usually runs several times a day, lasts about two-and-a-half hours and costs £14 (Dh67)
Harry Potter and the Cursed Child is on now at the Palace Theatre. Tickets need booking significantly in advance
Entrance to the Harry Potter exhibition at the House of MinaLima is free
The hotel: The grand, 1909-built Strand Palace Hotel is in a handy location near the Theatre District and several of the key Harry Potter filming and inspiration sites. The family rooms are spacious, with sofa beds that can accommodate children, and wooden shutters that keep out the light at night. Rooms cost from £170 (Dh808).
Sri Lanka squad
Dinesh Chandimal, Dimuth Karunaratne, Kaushal Silva, Kusal Mendis, Angelo Mathews, Lahiru Thirimanne, Niroshan Dickwella, Sadeera Samarawickrama, Rangana Herath, Suranga Lakmal, Nuwan Pradeep, Lakshan Sandakan, Vishwa Fernando, Lahiru Kumara, Jeffrey Vandersay, Milinda Siriwardana, Roshen Silva, Akila Dananjaya, Charith Asalanka, Shaminda Eranga and Dhammika Prasad.
More Iraq election coverage:
Crops that could be introduced to the UAE
1: Quinoa
2. Bathua
3. Amaranth
4. Pearl and finger millet
5. Sorghum
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The National Archives, Abu Dhabi
Founded over 50 years ago, the National Archives collects valuable historical material relating to the UAE, and is the oldest and richest archive relating to the Arabian Gulf.
Much of the material can be viewed on line at the Arabian Gulf Digital Archive - https://www.agda.ae/en
The specs: 2018 Maxus T60
Price, base / as tested: Dh48,000
Engine: 2.4-litre four-cylinder
Power: 136hp @ 1,600rpm
Torque: 360Nm @ 1,600 rpm
Transmission: Five-speed manual
Fuel consumption, combined: 9.1L / 100km
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The more serious side of specialty coffee
While the taste of beans and freshness of roast is paramount to the specialty coffee scene, so is sustainability and workers’ rights.
The bulk of genuine specialty coffee companies aim to improve on these elements in every stage of production via direct relationships with farmers. For instance, Mokha 1450 on Al Wasl Road strives to work predominantly with women-owned and -operated coffee organisations, including female farmers in the Sabree mountains of Yemen.
Because, as the boutique’s owner, Garfield Kerr, points out: “women represent over 90 per cent of the coffee value chain, but are woefully underrepresented in less than 10 per cent of ownership and management throughout the global coffee industry.”
One of the UAE’s largest suppliers of green (meaning not-yet-roasted) beans, Raw Coffee, is a founding member of the Partnership of Gender Equity, which aims to empower female coffee farmers and harvesters.
Also, globally, many companies have found the perfect way to recycle old coffee grounds: they create the perfect fertile soil in which to grow mushrooms.
Herc's Adventures
Developer: Big Ape Productions
Publisher: LucasArts
Console: PlayStation 1 & 5, Sega Saturn
Rating: 4/5
Gifts exchanged
- King Charles - replica of President Eisenhower Sword
- Queen Camilla - Tiffany & Co vintage 18-carat gold, diamond and ruby flower brooch
- Donald Trump - hand-bound leather book with Declaration of Independence
- Melania Trump - personalised Anya Hindmarch handbag
