Appreciation and Encouragement for Health Insurance Players in Place of Hatred and Vilification

More than a month ago, on a winter morning at around 7 A.M. Brian Thompson, then CEO of UnitedHealthcare, the insurance arm of UnitedHealth Group was shot outside the New York Hilton Midtown hotel. He was walking to a conference in Midtown Manhattan and the shooter came right behind him and fired fatal shots at him. The incident shocked the nation when it is least expected to come in this manner. When does corporate executives become target of common man who has bad intentions for the system. Any outcome has peaceful pathways to achieve but this kind of violent outburst has no place in civil world. The news hit me more because of the industry affiliation as I am working in the U.S. health insurance domain for the last many years. I even came to U.S. on this job and has been doing my job for the last 2 years 9 months while contributing to this country with all my sweat. Inflicting violence on this bracket definitely bothered my thoughts. I am no expert in this health insurance domain to tell why this happened but the killer’s motive appears to be linked to his critical views on health insurance industry. He expressed disdain for corporate practices that he believed harmed many people. That doesn’t warrant extreme steps and action which is highly condemnable. While this act elicits rebuke, as something which fed me all the while I am highly positive about U.S. health insurance industry. The common man owes to U.S. health insurance, the hospitals owe to health insurance market and the nation owe to this very domain. Instead of appreciating and supporting this vital link, making this as soft targets and creating a negative environment is highly uncalled for. If you are pleased and benefitted by their actions, please support them. Infact everyone should encourage these players for doing tremendous service to the nation by forming a vital bridge between patient and provider in this highly developed world. By doing this job, they are making the job of everyone easy. Once again, this service needs appreciation not targeted attacks. 

Let me tell you about this great service from these players working with all good intentions and improving the health of the nation. A patient came for an emergency surgery and it would cost $20,000 for the procedure. The patient’s share might total around $3,700 with a medium deductible, with the insurer covering the remaining $16,300. The patients burden of $16300 has been taken care by the insurer. Blame the high operation costs, high provider costs, high medical costs, high drug costs etc. but not the insurer who reduced the bill for the patient with his wonderful work of aggregating and distributing benefits. Simply, in an uninsured world, the patient needs to bear the entire $20000. The cost for a patient on Breast cancer treatment can exceed $100000 annually. With insurance, the patient pays $8500 and the remaining 91500 will be covered by insurer without inflicting catastrophic financial hardship. For a child birth, a routine vaginal delivery costs between $10,000 and $15,000, while a cesarean section may cost $20,000 to $30,000, including prenatal care and hospital stay. For a $12,000 vaginal delivery, patient may pay $4000 from his pocket and the remaining 8000 will be covered by the insurer. Annual costs can exceed $6,000 to $12,000 for insulin for diabetes. Many insurance plans cap monthly insulin costs at $35 per month under new regulations, totaling $420 annually. The insurer covers the rest, saving the patient thousands. Mental health therapy sessions typically cost $100 to $200 per session, with annual costs of $5,000 or more for weekly visits. Assuming a $20 copay per session, for 50 sessions a year, the total cost is $1,000 while the insurer covers the remaining $4,000 to $9,000. From all these examples, a patient in U.S. is living with a free mind without tensions due to the astronomical costs absorbed by the insurance players. Once again, you can blame the high costs on anyone else when the insurer is actually reducing the costs and lowering the burden. When you are lowering the costs for a patient, you deserve every bit of praise and support for continuing to do what you do. 

The incident of killing sparked a national outcry over the U.S. healthcare system, including its denied claims and high costs. As mentioned, the high costs are not in the purview of insurance domain and as long as the operation model elicit high costs, the insurance players will exist. As far as denied claims are concerned, most claims for treatment are generally approved by these players as long as they are rational. For instance, reports from 2023 highlight that insurers like Blue Cross Blue Shield and Aetna maintained claim approval rates exceeding 85%, reflecting strong adherence to policy commitments. Medicare, which serves millions of seniors and disabled individuals, demonstrated an impressive claim approval rate of over 96%, ensuring that beneficiaries receive the care they require. Large employers’ health plans, as analyzed by the Kaiser Family Foundation, also showed consistent approval rates, with most claims being processed successfully. UnitedHealthcare reported a significant improvement in claim turnaround time, with 90% of claims processed within 10 business days. When more than 85% of claims you make for thousands and thousands of dollars are approved, you are staring at very good record of supporting people lower their costs for high quality treatment and get healthier. You are simply helping people for great health outcomes by improving their health.  

This doesn’t mean the remaining 15% people with denied claims need to get disappointed and groom hatred over the system. A 2024 report by Experian Health revealed that 38% of surveyed healthcare providers experienced denial rates of at least 10%, with some organizations facing rates exceeding 15%. In Pennsylvania, the 2024 Transparency in Coverage Report disclosed that insurers denied approximately 2.1 million claims, resulting in a denial rate just below 14%, a decrease from the previous year. As we can see there is a threshold of 15% claims to get denied due to various reasons which is expected for a big industry like this. We need to transition towards 100% claim approval rate by satisfying each and every patient and provider. It asks for lot of responsibility from everyone who make a claim and nevertheless, the insurers don’t have hard feelings towards anyone to deny a claim rather than algorithms doing their job. 

The insurers are very good in their jobs by lowering the burden on patients and improving the claim approval rates. This doesn’t stop here. There are several other avenues through which they assist the health care world and the nation by stirring up the economies and moving mountains. Health insurance encourages preventive care by covering routine check-ups, screenings, and vaccinations. Annual screenings for conditions like diabetes, hypertension, and cholesterol are covered, leading to early intervention. Vaccinations for diseases such as flu, COVID-19, and HPV are often free under insurance plans, helping prevent widespread illnesses. Many health insurance plans include prescription drug coverage, ensuring patients can afford necessary medications. People with chronic conditions like asthma, diabetes, or heart disease benefit from reduced costs for essential medications like insulin, inhalers, and blood pressure drugs. Modern insurance plans often include mental health and wellness services, recognizing their importance to overall well-being. Therapy sessions, psychiatric consultations, and medications for conditions like anxiety and depression are often covered including physical and mental well-being. Health insurance provides comprehensive maternity care, ensuring better health outcomes for mothers and babies. In life-threatening situations, health insurance ensures that individuals receive immediate care without the barrier of upfront costs. Victims of car accidents or severe injuries often face hospital bills exceeding $50,000. Insurance ensures access to necessary surgeries and rehabilitation. Patients with diabetes receive coverage for regular doctor visits, glucose monitors, and diabetic supplies. Health insurance plans increasingly cover virtual visits, ensuring convenient and accessible care. Patients in remote areas or those with mobility challenges can consult with doctors via telehealth platforms. Government-sponsored programs like Medicaid and the Children’s Health Insurance Program (CHIP) ensure low-income families, children, and disabled individuals receive necessary care. Health insurance plays a significant role in funding hospitals, research centers, and pharmaceutical companies, driving medical innovation. 

Through financial protection, preventive care, access to essential treatments and driving innovation, the U.S. health insurance system supports millions of people in living healthier and more secure lives. While there is room for improvement, the system plays an undeniable role in promoting individual and public health. The health insurance sector contributes to economic growth by generating millions of jobs, from healthcare administrators to actuaries. I have been serving two nations at large– U.S. and India by virtue of my tiny job in this health insurance domain. The people like me are thousands in U.S., India and places elsewhere. Try to help us, try to lessen our burden, try to lessen our challenges, try to serve us serve you and try to look at the other side of the coin. Having these demi-gods who enable this great system for your targeted attacks is pathetic and highly deplorable. We cannot encourage one and all to breed hatred and at the same time bring to the table a host of areas serving everyone. We cannot face hatred and continue doing lot of good at the same time.

We all have an obligation to improve health care domain in U.S. Let us work towards improvements and not poor attacks. We need to remind everyone towards the greater goals for the nation as far as health care is concerned. Yes, the high costs are a concern for everyone. It hit me badly as well. I need to cough up $2500 for a small dental treatment and cleaning since I unfortunately have no dental coverage. Imagine paying more than half of your salary or 2 lakh rupees for a dental procedure. Back in India, I would have been treated for 20000 rupees or less than 10% of the total cost in U.S. The nation needs to travel back as far as health care is concerned where third world countries are living in much better health and care system. There are bigger objectives we definitely need to work towards to make a nation which cares for its citizens health. The U.S. has some of the highest healthcare costs globally, making care unaffordable for many. Millions remain uninsured or underinsured, limiting access to essential care. Strengthen programs like Medicaid and the Affordable Care Act (ACA) and explore universal healthcare options or public insurance alternatives to ensure coverage for all. When the costs are reduced, the premiums will reduce and the total money in the system will reduce without overtly frightening about the high amounts we are seeing today. There has to be Indian mindset towards treating American health care system. Studying the Indian landscape will teach you numerous benefits with the important one aimed at lowering costs for care. For example, medical tests that might cost $10,000 in the U.S. can be done for as little as $50 in India. Hence, we need to engineer the Indian mindset towards treating the American health care problems. Bring more Indians and listen to them to treat this complex problem from its root. I can write a separate post on this approach.

Finally, we need to go further with health care in U.S. We cannot stay stagnant for so long with all the problems piling up. While recognizing the strong points like health insurance domain in U.S., we need to optimize the health care system as a whole to march ahead. We cannot leave a poor person like me behind and uninsured. Making the system work effectively and efficiently should be our business to reduce the brooding public hatred.