UnitedHealthcare
One of the largest commercial health insurance companies in the United States, operating as a subsidiary of UnitedHealth Group. The company provides health insurance coverage to millions of Americans and is known for its claims management processes and prior authorization mechanisms.
Timeline (last 90 days)
Last Week Tonight recently produced an episode focused on claim denials and prior authorization practices at US health insurance giant UnitedHealthcare.
UnitedHealthcare's parent company, UnitedHealth Group, is the largest health insurance group in the United States.
A 2023 class-action lawsuit against UnitedHealthcare alleged that it used an AI model called nH Predict to mass-deny rehabilitation care claims for elderly patients.
The nH Predict model reportedly had a denial rate far exceeding the human review benchmark, and the algorithmic logic was completely opaque to policyholders.
In the episode, a family whose child has a rare neurological disorder described submitting the same claim for physical therapy and occupational therapy every month, only to be denied every month.
In the episode, that family ultimately relied on employer-coordinated donations to pay for a new shower chair costing $1,800, rather than obtaining reimbursement through insurance.
All Facts (6)
UnitedHealthcare's parent company, UnitedHealth Group, is the largest health insurance group in the United States.
50%UnverifiedThe nH Predict model reportedly had a denial rate far exceeding the human review benchmark, and the algorithmic logic was completely opaque to policyholders.
50%UnverifiedLast Week Tonight recently produced an episode focused on claim denials and prior authorization practices at US health insurance giant UnitedHealthcare.
50%UnverifiedA 2023 class-action lawsuit against UnitedHealthcare alleged that it used an AI model called nH Predict to mass-deny rehabilitation care claims for elderly patients.
50%UnverifiedIn the episode, a family whose child has a rare neurological disorder described submitting the same claim for physical therapy and occupational therapy every month, only to be denied every month.
50%UnverifiedIn the episode, that family ultimately relied on employer-coordinated donations to pay for a new shower chair costing $1,800, rather than obtaining reimbursement through insurance.
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