A message left at the scene of a health 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 claims, denying claims and defending their actions.

The phrase has been used to describe many types of insurers — auto, property, and health.

“The longer they can delay and deny the claim, the longer they can hold onto their money and they’re not paying it out,” said Lea Keller, managing partner at Lewis and Keller, a North Carolina-based personal-injury law firm.

“Delay, Deny, Defend” is also the title of a 2010 book by Jay Feinman that delves into how insurers handle claims.

“All insurance companies have an incentive to chisel their customers in order to increase profits,” says an excerpt on the book's website.

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 procedures and prevent the overuse of care to help control 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.

“Many Americans view these companies as driven by profit rather than a commitment to serve their customers,” said Mario Macis, a Johns Hopkins economist who studies trust in the health care system. “And this creates a big disconnect.”

Anger and vitriol against health insurers filled social media in the wake of Thompson's killing. Users’ reactions — and in many cases jokes — populated comment sections teeming with frustration toward health insurers broadly and UnitedHealthcare in particular.

“I would be happy to help look for the shooter but vision isn’t covered under my healthcare plan,” one comment read on Instagram.

“Thoughts and prior authorizations!” wrote another user.

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 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 and health writer Devi Shastri in Milwaukee contributed to this report. Murphy reported from Indianapolis.

___

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.

Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.