Common health care questions
How does health insurance work?
Insurers provide unique value to the health care system by administering benefits, paying claims, negotiating reimbursement rates with care providers to make care more affordable, and reducing fraud on behalf of employers, governments and the members enrolled in their plan.
Plan sponsors
set coverage
Governments and employers establish benefit coverage which can vary widely based on plan design.
Insurers provide services
Collect premiums and pool resources.
Pay claims.
Negotiate price discounts.
Minimize fraud, waste or abuse.
Guide to highest value sites of care.
Insurers create value
Pooling of resources
Reduces individual out-of-pocket expenses and provides access to those who otherwise may be unable to afford it.
Support health care vs. sick care
Incentivized to keep consumers healthy and make care more affordable.
How many claims are approved and paid?
UnitedHealthcare approves and pays 98% of valid claims.
UnitedHealthcare understands that consumers and providers are frustrated when health care visits, procedures or medications aren’t covered. That’s why UnitedHealthcare is committed to helping all stakeholders better understand the claims approval process and pursuing opportunities to streamline that process.
Where does your health insurance dollar go?
Medical costs
(80% - 85%)
Premium dollars on patient care and care-related activities.
Administration
(10%)
Spent on claims processing and member services.
Profit
(5%)
Profits after claims and admin are allocated to shareholders.
Insurers must maintain adequate reserves and an appropriate return on capital to remain financially stable, compliant with regulations and capable of paying claims for policyholders.
Insurers invest a significant portion of earnings back into their businesses to drive innovation, advance care coordination programs, and simplify experiences for members and providers.
Why is health care in America so expensive?
Health care costs in the U.S. are almost twice as expensive as in other developed countries.
The higher cost is due to higher prices for things like visits to the doctor, surgical procedures, hospital stays and medications.
The U.S. health care system prioritizes immediate access to a broad range of health services. On the contrary, many other countries restrict access as a tool to keep health care costs lower.
The U.S. has the highest chronic disease burden among developed countries. Many of these chronic diseases are preventable and linked to lifestyle factors.
To compensate for the lower payments from Medicare and Medicaid, health care providers charge higher rates to commercial insurers. This means employers in effect subsidize the lower rates from government programs, which drives up the cost of care for the employees enrolled in their plans.
How can UnitedHealth Group make the system work better?
We know there is more work to do, and we believe our experience and expertise can help drive real change.
Lead in personalized experiences
Deliver consumer-directed, best-in-class products and experiences that eliminate friction and enable transparency in a member's health care journey.
Enable the full potential of value-based care
Advance the transition from a fee-for-service to a value-based system of care delivery to better manage health care costs and improve the patient experience.
Shift administrative processes and enable transparency
Simplify underlying structures and advance innovation across provider networks to enable transparency and real-time processing, allowing consumers to make informed decisions based on cost.