Not since the 1960s have assassinations been so frequent in the United States. First someone tried to kill Donald Trump and failed. And now, someone has shot Brian Thompson, the UnitedHealthcare chief executive officer (CEO) who, until recently, was largely unknown.

While politicians have always been at risk, this is the first time that the target of an assassination has been an ordinary citizen, whose only ‘crime’ was that he headed a healthcare company that is famous for pulling the rug out from under their clients’ feet just when they need it most.

What’s even more revealing is the public reaction on social media platforms. Instead of an outpouring of sympathy for the victim and outrage against his killer, social media platforms are flooded with jokes and a gleeful cheering of the killer. “Patient has a history of shootings, coverage denied,” said one post. “I’m sorry, prior authorisation is required for thoughts and prayers,” said another.

According to the New Yorker’s lead article, UnitedHealthcare had to switch off the comments section on LinkedIn on their post about Thompson’s death, as so many people were liking and applauding it. Facebook had to follow suit, as their post received over 36,000 laugh reactions within 24 hours.

One Reddit comment from a nurse summed it up elegantly. “Honestly, I’m not wishing anyone harm, but when you’ve spent so much time and made so much money by increasing the suffering of humanity around you, it’s hard for me to summon empathy that you died. I’m sure someone somewhere is sad about this. I am following his lead of indifference.”

The news of the shooting that led to the death of UnitedHealthcare CEO Brian Thompson resulted in so many people liking and applauding it on social media that the company had to turn off comments. Novelist Radhika Jha, through her own experience of dealing with the US insurance giant, delves into why there was such a dearth of sympathy and who is to blame for such a situation…

I am ashamed to say that I, too, felt little sympathy for Thompson, even though he was gunned down in cold blood. Nor could I summon anger at his killer. I could understand very well what had driven him to take this extreme, self-destroying step.

On the site of the killing, the police found bullets on to which the killer had inscribed ‘deny’, ‘delay’ and ‘depose’. The first two words echo a 2010 book by Jay Feinman, titled Deny, Delay, Defend: Why Insurance Companies Don’t Pay Claims And What You Can Do About It.

The tangled web of insurance claims

What I hadn’t bargained upon was that not only do insurance companies deny and delay payments, they also lie to you on the helpline. Having just come from Greece, I took good health insurance coverage for granted and was happy when I was told that my husband’s company had insured the family with the “largest healthcare provider in America” — surprise, surprise — UnitedHealthcare. 

I was given a book as thick as the Bible and told, “This is your insurance coverage, please read it carefully. If you have any problems, you can also check the website. And if you still don’t understand, there is a helpdesk number on the back of your card, call them.” 

My first and only problem surfaced roughly five months later, when I tried to find a psychologist for my son, who was having problems at school. Coming out of the pandemic, skipping a grade in high school, and being thrown into a new country and a new culture had seriously affected him. His grades had slipped, and he was anxious and visibly depressed. 

The school psychologist advised me to get help from a trained psychiatrist. She recommended one to us and asked me what insurance I was under. I told her proudly, “UnitedHealthcare Choice Plus” (the broadest on paper at least). 

Her face went carefully blank. “Here is the number of Dr Rogers (name changed), who I know has helped several students from our school with problems similar to your son’s. She may have an opening. With the pandemic, it’s difficult to find a doctor for mental health issues, they are all booked up. I can call  for you,” she told me, adding, “See if they can squeeze your son in. However, they may not be in-network for your insurance company. You should call and check.”

“What is in-network?” I asked innocently.

“Every insurance company has a pool of doctors with which they work and, when you go to see them, the insurance covers most or all of the bill. However, if you go outside this group of doctors, then the insurance only pays some part of the bill.” 

One call to the doctor’s office told me that they were ‘out-of-network’ and, therefore, the bills would not be paid by the insurance company. What were their charges? $325 for a 50-minute session. Stunned, I then called the helpdesk number of UnitedHealthcare. 

An hour later and having gone through all the identification rigmarole, I was at last talking to a human (I think) and was told that I would be sent a secured email on my account on their website, with names of psychiatrists in my area who were covered by UnitedHealthcare and I could choose one.

“But how do I get into the website?” I asked.

“Oh,” the person said airily, “You will have to set up your account first and then you can access your message.”

After another 45-minute wait with another helpline dedicated to helping people set up their accounts, it took me a day and a half to get it up and running. All this, only to

find out that there were no psychiatrists available in the Upper East Side [Manhattan, New York]. 

The only in-network doctors were in Long Island City, Long Island or in Hoboken in New Jersey. When you are in a foreign country and you have a child with mental health problems, you make decisions quickly and without considering the costs. I decided to go out-of-network. I had never been to Hoboken or Long Island City and had no idea how good the doctors there were. But I did know the school psychologist and trusted her opinion. 

Back I went to the homepage of the website and looked up out-of-network costs and coverage. “UnitedHealthcare offers the best out-of-network coverage of any insurance company in America,” I read, “covering 70 percent of out-of-network provider charges, with a deductible of $1,000 per individual, $2,000 per family.”

Deductible? Provider? What did these words even mean? I was lost. 

Someone on the helpline told me that once I spent $1,000 out of my own pocket, I could start claiming reimbursement. All we had to do was fill out a claim form after setting up an account and 70 percent of the bill, after the $1,000 initial payout, would be reimbursed by the insurance company.

But what she didn’t say, and what the website also doesn’t mention, is that the 70 percent reimbursement is not based on your actual medical costs, but an arbitrary amount which they decide. This amount also affects your deductible. 

Promises vs reality

UnitedHealthcare caps a mental health professional’s fees at $90-100. So my deductible was met in 10 sessions, instead of three. Ten sessions with the out-of-network psychotherapist cost me $3,250. And after that first $3,250 were spent, I only received $66 per session, when in fact I was paying $325. At the end of the year, the deductibles flipped back to zero and I had to pay another 3,250 up front.

When I finally did the math, I realised that for a year’s therapy, which cost me close to $20,000, I was reimbursed roughly seven percent. As for the expensive tests the psychiatrist prescribed, they were denied because of a lack of “previous authorisation.” 

Of course, neither the person on the helpline nor the website said anything about which tests needed previous authorisation and which didn’t. All I got was mechanical advice to get in touch with an agent to find out if the ones my son’s psychiatrist had suggested needed authorisation or not.

When I did contact the company’s helpline, I was told that I didn’t need authorisation and all I had to do was to send in the bills.

Even the information about the $100 cap came to light only when I contacted the agent who had sold the policy to my husband’s company. She, too, was

clueless about the $100 ceiling on reimbursements, until she began to investigate through her contacts within the UnitedHealthcare bureaucracy.  

UnitedHealthcare’s helpline had misinformed me. “You will get 70 percent of $325,” they repeated time and again, when this was totally untrue. 

To be fair, the helpline for UnitedHealthcare is probably being manned out of a call centre in India or the Philippines and the people there were just repeating what was written on the website or what came up in their Google search. 

But what I cannot forgive UnitedHealthcare for, is not writing these things on their website in simple English. 

I wanted to press charges, but was told by my husband’s company lawyer that it would be expensive and a waste of time. They had far better lawyers on retainer and would only defend, delay and deny.

Sadly, I had not read Feinman’s book at the time. But I had read Charles Dickens’ Great Expectations, which is about an interminable lawsuit that drives the plaintiffs to bankruptcy and suicide. I just never imagined that it would be the same two centuries later in 21st century America.

Why such little sympathy for Thompson?

UnitedHealthcare is famous for denying insurance claims. According to Value Penguin, a consumer research site specialising in insurance, one in three claims were denied by the company last year. In the same period, the company made $281 billion in revenue. 

Thompson earned over $10 million last year, not including what he holds in stocks of a company valued at around $550 billion on the stock market. During his tenure, the company’s profits rose from $12 to $16 billion. 

How is one expected to feel compassion for someone who is the head of such a company, even if he did try to change things from the inside? Who bears the responsibility for an oppressive system that denies help to those when they most need it and who forces doctors, who have taken the Hippocratic oath, to forsake their patients? 

When one thinks of the American stock market, Apple, Amazon, Nvidia and, of course, Elon Musk come to mind. But UnitedHealthcare is in there too. It is among the top 20 highest valued companies in the US. So who is the CEO of such a company ultimately answerable to? Clearly, he is responsible to the shareholders, who expect him to deliver ever-increasing amounts of profit.

Most Americans prefer private insurance over public healthcare systems. They pay the highest amount for this health insurance and yet, in terms of life expectancy, the US comes at number 48, as mentioned by Thompson’s killer in his note. Europe too, with its now severely stressed but still functioning public healthcare, has a higher life expectancy as a whole than the US. 

To cap it all, the premiums for private healthcare for a family are enormous. My husband’s company paid around $21,600 annually for the four of us while we were in good health. And yet, when we had a problem, we got nothing. 

The insurance agent, who helped me get to the bottom of why I wasn’t getting reimbursed, told me that most American families paid between $15,000-$30,000 a year on out-of-pocket health expenses, so we were in that ‘normal’ bracket. 

Do you blame people or the system?

When one comes to New York as a tourist, one is amazed by the wealth, the opulence and the energy of the city. But only when one lives in it does one begin to understand that the wealth is enjoyed by a very few and that the energy is also born out of anxiety. 

As an American friend said, “In this city, everyone is just one step away from financial ruin. A divorce, a job loss or a health problem and you can end up on the street within weeks.” 

This is also why the most looked up college statistic by young people today is the average earnings of graduates. Young Americans, especially in New York, know what their future holds.

If they want to have a house, a partner, a family, then they must work for a big company, which will cover their health insurance and give them a regular income that will enable them to pay off their college loans. 

Thompson did what he had to do, followed orders and moved up in the professional echelons. His life was an American success story, the American Dream.

However, the fact is that today, the US is not the land of opportunity for all but for just a few  people. And even those who are lucky enough to be able to live the American dream are forced to submit to the merciless logic of profit-making. 

In some industries such as health, this means turning a blind eye to suffering. So, can you blame the people who walk the tightrope every day — not knowing when a fight could turn into a divorce, a sneeze into bankruptcy or helping a client into job loss — for feeling too exhausted for empathy?

The writer is an award-winning Indian novelist and her latest book The Hidden Forest will be out next month

By arrangement with The Wire

Published in Dawn, EOS, December 29th, 2024