Public response to the murder of Brian Thompson by alleged shooter Luigi Mangione reveals depth of rage toward insurance industry

Anyone who has tried to get insurance to cover their mental health bills knows how frustrating and dehumanizing the process can be. For millions of Americans, it’s downright impossible.

More than half of all psychiatrists and most therapists won’t take insurance, much less Medicare or Medicaid. They say there’s too much hassle and the reimbursement rates are too low to make it worth their while. If patients want care, they’ll have to pay for it by themselves.

Those who can’t afford to pay $150 or more an hour are left scrambling to find a provider in a marketplace critically lacking trained clinicians. This is especially true for children with serious mental illness. There is a severe shortage of child psychiatrists, with fewer than 14 psychiatrists for every 100,000 children in America at last count. 

Even if you can find a provider who takes your insurance, then you face the hurdle of getting your claim approved. Increasingly, insurance companies are capping the number of therapy visits they will allow or they deny claims altogether as “not medically necessary.” Often, these decisions are made by a panel of so-called “care managers,” most of whom have no mental health training. 

Bottom line: at the same time insurance companies are enjoying record profits, millions of Americans who desperately need mental health care are being abandoned, left to suffer without care no matter how urgent, or even lethal, their case may be.

The recent murder of UnitedHealthcare CEO Brian Thompson exposed the frustration and outrage of thousands of disgruntled insurance customers whose claims have been rejected. By some estimates, United Healthcare, which last year earned profits of $16.4 billion, has an industry-leading denial rate, nixing almost one-third of all claims – including one for a person with a broken back.

While no rational person would condone murder as the answer to those inequities, the attention has crystallized the issues and emboldened critics to speak up. Tens of thousands of people posted on social media decrying insurance industry practices and some 84,000 people reacted with a laugh emoji to a condolence note posted on Facebook by the company.  Meanwhile, mental health professionals are taking stock of the wreckage.  

“For too long, decisions made in boardrooms and C-suites have been shielded by wealth, power, and distance from the human suffering they create,” Brittainy Lindsey, a licensed mental health counselor and health care consultant posted on her LinkedIn account the day after Thompson’s killing. “The profiteering off illness, the exploitation of clinicians—these are not abstract harms. They are as real as the murder of a rich person in broad daylight – deeply personal, inflicting pain on the individuals and communities affected.”

The response to Lindsey’s post was swift and heated, with more than 400 comments, most amplifying her outrage at a system that has too long abided discrimination in coverage.

Lindsey’s post and dozens of other commentaries published in the days after Thompson’s murder serve as a rallying cry for insurance reform and true parity, both long overdue. 

It begins with patients being proactive in demanding that their claims be paid.

Joe Feldman, a business development consultant from Chicago, was so infuriated when his daughter’s mental health insurance claims were denied a decade ago – care recommended by her doctor – that he sued his health insurer and won in federal court.

 Last year, Feldman started a non-profit organization to help others successfully wage their own challenges. Cover My Mental Health provides action steps, worksheets and templates of letters for customers to send to their insurance providers demanding coverage. 

It’s not enough to submit a claim and hope for the best, Feldman says. You have to be aggressive and insist that these illnesses be treated like any other disease. 

“Can you imagine a health insurance company so committed to mental health and substance use disorder care that they actively recruit clinicians to assure a robust network offering a speedy on-boarding process, competitive reimbursement rates, and unfettered decisions about medical necessity?” Feldman asked, with a rhetorical flourish. “Me neither.”

Though parity laws were first passed in 1996, enforcement has been scant.

In 2018, California regulators clamped down on United Healthcare’s systemic denial of mental health care claims. Two years later, the Massachusetts Attorney General’s office did the same. 

The state of New York sued United Healthcare for violating parity laws. In 2021, the company agreed to pay more than $18 million in regulatory fines, reimbursements and attorney fees.

But a series of articles by ProPublica last summer examined UnitedHealth Group’s internal playbook and found how the company is able to continue to deny coverage to millions of people. 

While federal regulators oversee plans that employers sponsor for their workers, each state is responsible for policing plans that individuals buy and the Medicaid plans that are run by private companies. So, once California, Massachusetts and New York prosecuted United for violating federal parity laws, the company simply focused its practices on the 47 other states where regulators were not as attentive. 

“It’s like playing Whac-A-Mole all the time for regulators,” Lauren Finke, senior director of policy at the mental health advocacy group The Kennedy Forum, told ProPublica. the news organization. 

Will the attention from this execution-style killing be a catalyst for reform?

Nicholas Rosenlicht, a psychiatrist and professor at the University of California, San Francisco, School of Medicine and the author of the book My Brother’s Keeper, says he hopes so. 

“Why do we continue to treat diseases of the brain differently than any other organ in the body,” he asks. Why, for example, is there a separate phone line for most insurance companies that customers must call for approval of a mental health claim?

“As long as we continue to marginalize people with mental illness we will exclude them from the care they so desperately need.”

The burden is on all of us to stay vigilant and call out insurance companies’ systemic discriminatory practices.

As a newspaper reporter covering mental health care for more than three decades, I interviewed legions of people who suffered with some form of mental illness but could not get care because they could not afford it. I saw them agonize and it never failed to outrage me.

It’s time to fix what is broken.

As health care policy consultant Lindsey says, “Are we ready to admit that the stakes are far too high to wait any longer?”

Meg Kissinger is a veteran journalist, Pulitzer Prize finalist and author of  While You Were Out: An Intimate Family Portrait of Mental Illness in an Era of Silence. She is a member of the MindSite News Editorial Advisory Board.