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.
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
Islamophobia definition
A widely accepted definition was made by the All Party Parliamentary Group on British Muslims in 2019: “Islamophobia is rooted in racism and is a type of racism that targets expressions of Muslimness or perceived Muslimness.” It further defines it as “inciting hatred or violence against Muslims”.
Pupils in Abu Dhabi are learning the importance of being active, eating well and leading a healthy lifestyle now and throughout adulthood, thanks to a newly launched programme 'Healthy Lifestyle'.
As part of the Healthy Lifestyle programme, specially trained coaches from City Football Schools, along with Healthpoint physicians have visited schools throughout Abu Dhabi to give fun and interactive lessons on working out regularly, making the right food choices, getting enough sleep and staying hydrated, just like their favourite footballers.
Organised by Manchester City FC and Healthpoint, Manchester City FC’s regional healthcare partner and part of Mubadala’s healthcare network, the ‘Healthy Lifestyle’ programme will visit 15 schools, meeting around 1,000 youngsters over the next five months.
Designed to give pupils all the information they need to improve their diet and fitness habits at home, at school and as they grow up, coaches from City Football Schools will work alongside teachers to lead the youngsters through a series of fun, creative and educational classes as well as activities, including playing football and other games.
Dr Mai Ahmed Al Jaber, head of public health at Healthpoint, said: “The programme has different aspects - diet, exercise, sleep and mental well-being. By having a focus on each of those and delivering information in a way that children can absorb easily it can help to address childhood obesity."
