A message left at the scene of an insurance executive’s fatal shooting — “deny,” “defend” and “depose” — echoes a phrase commonly used to describe insurer tactics to avoid paying claims.
The three words were written on the ammunition a masked gunman used to kill UnitedHealthcare CEO Brian Thompson, according to two law enforcement officials who spoke to The Associated Press on condition of anonymity Thursday. They're similar to the phrase “delay, deny, defend” — the way some attorneys describe how insurers deny services and payment, and the title of a 2010 book that was highly critical of the industry.
Police haven't officially commented on the wording or any connection between them and the common phrase. But Thompson's shooting and the messages on the ammunition have sparked outrage on social media and elsewhere, reflecting a deepening frustration Americans have over the cost and complexity of getting care.
“Delay, deny, defend” has become something of a rallying cry for insurance critics. The terms refer to insurers delaying payment on healthcare claims, denying claims and defending their actions.
“Delay, deny, defend” is also the title of a 2010 book by Jay Feinman that delves into how insurers handle claims.
UnitedHealthcare provides coverage for more than 49 million Americans and brought in more than $281 billion in revenue last year as one of the nation’s largest health insurers. UnitedHealthcare and its rivals have become frequent targets of criticism from doctors, patients and lawmakers in recent years for denying claims or complicating access to care.
Critics say insurers are increasingly interfering with even routine care, causing delays that can, in some cases, hurt a patient's chances for recovery or even survival.
Doctors and patients have become particularly frustrated with prior authorizations, which are requirements that an insurer approve surgery or care before it happens.
UnitedHealthcare was named in an October report detailing how the insurer’s prior authorization denial rate for some Medicare Advantage patients has surged in recent years. The report from the U.S. Senate Permanent Subcommittee on Investigations also named rivals Humana and CVS.
Insurers say tactics like prior authorization are needed to limit unnecessary care and help control spiraling medical costs.
Frustrations extend beyond the coverage of care. Expensive breakthrough medications to slow Alzheimer’s disease or help with obesity are frequently not covered or have coverage limits.
In the U.S. health care system, patients get coverage through a mix of private insurers such as UnitedHealthcare and government-funded programs such as Medicaid and Medicare. That can prove particularly frustrating for doctors and patients because coverage often varies by insurer.
Polls reflect those frustrations with the U.S. health care system in general and insurance companies in particular.
About two-thirds of Americans said health insurance companies deserve “a lot of blame” for high health care costs, according to a KFF poll conducted in February.
A 2023 KFF survey of insured adults found that most give their health insurance an overall rating of “excellent” or “good” — but a majority also said they experienced a problem using their insurance in the previous year. That included denied claims, provider network problems and pre-authorization problems. Nearly half of insured adults with insurance problems said they were unable to resolve them satisfactorily.
AP polling editor Amelia Thomson-DeVeaux in Washington contributed to this report.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
The UnitedHealthcare headquarters in Minnetonka, Minn., lowered its flags to half-staff on Wednesday, Dec. 4, 2024, in honor of CEO Brian Thompson, who was fatally shot outside a hotel in New York. (Kerem Yücel/Minnesota Public Radio via AP)
This image provided by the New York City Police Department shows a man wanted for questioning in connection to the investigation of the killing of UnitedHealthcare CEO Brian Thompson outside a Manhattan hotel, Wednesday, Dec. 4, 2024. (New York City Police Department via AP)
Bullets lie on the sidewalk at the scene outside the Hilton Hotel in midtown Manhattan where Brian Thompson, the CEO of UnitedHealthcare, was fatally shot, Wednesday, Dec. 4, 2024, in New York. (AP Photo/Stefan Jeremiah)
MELBOURNE, Australia (AP) — It's not often that a man is able to follow up his first Grand Slam title by repeating as the champion at the same tournament a year later, which is what Jannik Sinner will be trying to do Sunday when he faces Alexander Zverev in the Australian Open final.
The last time it happened was nearly 20 years ago: Rafael Nadal accomplished that sort of repeat at the 2005 and 2006 French Opens. He turned out OK.
For the No. 1-ranked Sinner, the past year also included the doping case that is still unresolved. He tested positive for a trace amount of an anabolic steroid twice in March, which didn't become public until his exoneration was announced shortly before the start of play at the U.S. Open — which he won. There is a hearing in the World Anti-Doping Agency's appeal scheduled in April.
“He finds playing tennis matches to be his safe place. That’s where he can go and do his thing and feel like this is what he knows, this is what he understands, what is what he’s good at. It become a home for him to step on to the court and play tennis,” said one of Sinner's two coaches, Darren Cahill, who will leave the team after this season.
“There's been a lot of pressure around him for the last nine months now, since April last year. He deals with it as well as anybody that I’ve ever seen deal with pressure," Cahill said. "He’s an amazing young man that’s been able to put that to one side. ... He has a clear conscience.”
Over these two weeks in Australia, Sinner also dealt with health issues. He got medical attention when he felt dizzy and had an upset stomach during his fourth-round victory against No. 13 Holger Rune, then cramping late in his semifinal win over No. 21 Ben Shelton.
“There's a lot of things going on, on and off the court. I try to isolate myself a little bit, trying to be myself on the court. Sometimes it’s a bit easier. There are days where it’s easier, days where I struggle a little bit more,” said Sinner, a 23-year-old from Italy who can become the youngest man to win consecutive championships at the Australian Open since Jim Courier in 1992-93.
“I'm just happy to put myself in this position again,” Sinner said, “to play for a big trophy again.”
Standing in his way is No. 2 Zverev, a 27-year-old from Germany who is 0-2 in previous major finals, losing both in five sets — to Dominic Thiem at the 2020 U.S. Open after taking the first two sets and holding a match point, and to Carlos Alcaraz at last year's French Open after leading by two sets to one. Zverev won his semifinal in Paris last June hours after an out-of-court settlement was announced in Berlin that ended a trial stemming from an ex-girlfriend’s accusation of assault during a 2020 argument.
Zverev got his spot in the Australian Open final — play is scheduled to start at 7:30 p.m. local time (3:30 a.m. EST) on Sunday — when 24-time major champion Novak Djokovic stopped playing because of a leg injury just one set into their semifinal on Friday.
This will be the first title match at Rod Laver Arena between the men seeded 1 and 2 since No. 1 Djokovic defeated No. 2 Nadal in 2019.
“Jannik has been the best player in the world for the past 12 months,” Zverev said. “There’s no doubt about it.”
That is not really up for debate.
Sinner went 73-6 in 2024 with eight titles, the most on the ATP Tour since 2016, and is currently on a 20-match winning streak that began late last season.
He is listed as a -275 money-line favorite against Zverev, according to BetMGM Sportsbook.
But don't expect Sinner to proclaim that status or be willing to talk about himself in glowing terms.
“Back of my head, I also know that I’m 23 years old, and I am not perfect, no? I know that I have things still to improve. I have certain areas where I can get better. That’s why we work,” Sinner said. “Every day is a big challenge. Every day you have a different opponent. You try to understand what’s happening. Sometimes you have some issues and then trying to understand that whatever works best for that day and trying to go for it.”
Alexander Zverev of Germany plays a forehand return to Novak Djokovic of Serbia during their semifinal match at the Australian Open tennis championship in Melbourne, Australia, Friday, Jan. 24, 2025. (AP Photo/Ng Han Guan)
Jannik Sinner of Italy plays a backhand return to Ben Shelton of the U.S. during their semifinal match at the Australian Open tennis championship in Melbourne, Australia, Friday, Jan. 24, 2025. (AP Photo/Ng Han Guan)
Alexander Zverev of Germany serves to Novak Djokovic of Serbia during their semifinal match at the Australian Open tennis championship in Melbourne, Australia, Friday, Jan. 24, 2025. (AP Photo/Ng Han Guan)
Jannik Sinner of Italy receives medical treatment during his semifinal match against Ben Shelton of the U.S. at the Australian Open tennis championship in Melbourne, Australia, Friday, Jan. 24, 2025. (AP Photo/Ng Han Guan)
Jannik Sinner of Italy signs autographs after defeating Ben Shelton of the U.S. in their semifinal match at the Australian Open tennis championship in Melbourne, Australia, Friday, Jan. 24, 2025. (AP Photo/Manish Swarup)
Alexander Zverev, right, of Germany embraces Novak Djokovic of Serbia after Djokovic retired from their semifinal match at the Australian Open tennis championship in Melbourne, Australia, Friday, Jan. 24, 2025. (AP Photo/Ng Han Guan)
Jannik Sinner of Italy reacts during his semifinal match against Ben Shelton of the U.S. at the Australian Open tennis championship in Melbourne, Australia, Friday, Jan. 24, 2025. (AP Photo/Ng Han Guan)
