Investors long trusted the company to deliver earnings beats, despite limited transparency. Now they want answers.

For years, UnitedHealth Group’s financial reporting has been a black box. That needs to change.

The largest healthcare insurer and provider in America, UnitedHealth is bigger by revenue than Apple or Exxon Mobil. But investors have limited visibility into what is actually driving UnitedHealth’s profits—or where the risks lie.

That is partly because its businesses are deeply intertwined. Its insurance arm has vast dealings with its health-services businesses, creating a maze of internal transactions and blurred business lines.

The opacity wasn’t a problem for Wall Street as long as the company kept delivering. With a steady record of beating earnings estimates and a soaring stock, investors were content to let details slide.

This year, the magic vanished. In April, UnitedHealth missed its quarterly earnings estimates and slashed its 2025 forecast. In May, Chief Executive Officer Andrew Witty abruptly stepped down, and the company suspended its outlook. Days later, The Wall Street Journal reported on a Justice Department criminal probe into its Medicare practices.

“Sunlight is the great disinfectant,” said George Hill, an analyst at Deutsche Bank. “If you have a lot of investor concerns around sources of profitability, transparency is a great way to address that.”

The stock is down nearly 40% in 2025. Medical costs have outpaced expectations, and regulators have cracked down on some coding practices in Medicare Advantage. Now, investors are rightly asking questions about how UnitedHealth really makes its money.

The company has signaled it hears such concerns. “The prevailing theme is that people want and need an even more reliable, consistently high-performing and fully transparent UnitedHealth Group,” returning CEO Stephen Hemsley said during this month’s annual meeting.

Here are the key ways that UnitedHealth can make good on that pledge:

First, provide more detailed disclosure across its four units

These are UnitedHealthcare, the insurer; Optum Health, which delivers care through clinics and doctors offices; Optum Insight, which focuses on technology and payments systems; and Optum Rx, which provides pharmacy services.

Three of those could stand alone as Fortune 100 companies. Yet detailed financial information about each is sorely lacking.

The Optum Health segment, for instance, showed $105 billion of revenue and $98 billion of operating costs in 2024. Financial disclosures offer no detail on how much it spent on medical care, staff or products—just a footnote saying it lumps all operating costs together. 

To be fair, the company’s health-insurance rivals aren’t exactly beacons of transparency. Many report only limited breakdowns across their insurance operations. But because their businesses are less complex, investors have an easier time analyzing risks and opportunities.

Take Humana. It is largely a play on Medicare Advantage. So when it reports medical costs, investors see them as a clear signal about that part of the industry. 

Give clearer disclosure on dealings between its business segments

Insurers are generally required to spend set amounts of every dollar they collect in premiums on care. The percentage paid out is called the medical loss ratio. The minimum typically ranges from 80 cents to 85 cents on the dollar, depending on the plan.

UnitedHealth’s complex structure allows it to pay some medical costs incurred by its insurance arm to itself. Owning both healthcare providers and insurers makes it possible for companies to effectively sidestep regulatory caps on insurer profits.

Last year UnitedHealth said it had $151 billion of dealings between its different segments. Almost all were payments by the insurance unit to the Optum side. But UnitedHealth doesn’t say which services were being paid for, and there is no breakdown that would help clarify whether the payments reflect competitive market rates. 

That leaves investors guessing. If Optum Health’s business depends largely on UnitedHealthcare’s steering patients its way, it is hard to judge how well it would perform on its own.

Provide greater clarity on the group’s acquisition sprees

UnitedHealth became an industry giant by rolling up smaller companies in a highly fragmented health landscape. Yet its disclosures regarding these purchases are mystifying.

That means investors can’t tell how much of its growth is acquisition-fueled versus organic. There is really no way to differentiate based on its public statements.

In its 2024 annual report, for instance, UnitedHealth didn’t disclose how many acquisitions it made in the year, the companies it bought, or how it allocated the purchase prices between different assets and liabilities.

The company’s cash-flow statement showed it spent $13.4 billion on “acquisitions and other transactions.” But it didn’t disclose a total dollar figure for acquisitions alone.

Meet stakeholders’ needs

In response to questions about its financial reporting, a UnitedHealth spokesperson said: “We strive to meet our stakeholders’ evolving need to understand our business performance through compliant, transparent and useful disclosures.”

The issues outlined above are just a start. Investors also want a clearer view of how different parts of its insurance segment—such as Medicare Advantage, Medicaid and commercial—are performing. That would help them understand where the recent challenges are concentrated.

Of course, being more open carries risks. Revealing detailed information could draw unwanted attention from regulators and competitors, especially with scrutiny mounting around Medicare Advantage. And the hard part about choosing transparency is that investors might not like what they see.

But sticking with the black box is becoming unsustainable.