PITTSBURGH — A poster showing a security footage scene of UnitedHealthcare CEO Brian Thompson being shot to death in Manhattan was put up outside the AHN Downtown Medical Center on Penn Avenue on Tuesday afternoon with a cryptic message: “Look for the helpers. You will always find people who are helping.”

The typewritten note on the poster — quoting advice for children facing a crisis from iconic television host Fred Rogers — appeared to suggest that Thompson's accused killer, Luigi Mangione, was acting as a “helper” in shooting the health insurance executive last week. Similar posters were put up around Market Square, which was decorated for the annual Holiday Market, Highmark and city police said.

Downtown security cameras captured the image of the person involved as a white female, wearing a black puffy jacket, black T-shirt with white images, cuffed boots and a red mask, according to Highmark, parent company of the Allegheny Health Network. She was also carrying a black laptop-style bag.

The incident reflects a larger uptick in expressions of animosity toward U.S. health insurers in the wake of the fatal shooting of Thompson on Dec. 4, after police said evidence suggested the killer was angry with the industry.

While some on social media have responded with efforts to set up GoFundMe campaigns for Mangione’s defense, insurers have moved to protect their employees. Highmark on Wednesday followed Downtown-based UPMC Health Plan in deleting executive bios from websites.

In a Dec. 6 email to Independence Blue Cross employees, CEO Gregory E. Deavens told staff to “limit your wearing of IBX — or AmeriHealth-branded apparel or accessories while commuting or out in public.” The Philadelphia-based health insurer said the company had not received any direct threats to employees, but the advice was given “strictly out of an abundance of caution.”

Independence officials declined to comment on security matters Wednesday; UPMC Health Plan declined to comment and Capital Blue Cross Blue Shield officials did not return calls.

In a statement Wednesday, Highmark said it was monitoring events surrounding the killing of the UnitedHealthcare chief executive.

“We place the highest priority on the safety and security of our team members at every level and we are continuously evaluating our processes and learning from experiences across the industry and elsewhere to be as effective as we can be,” the statement read. “Both Allegheny Health Network and Highmark maintain high consumer satisfaction scores within the industry and our sole mission is to improve health and wellness.”

Since the arrest, police have said they’ve found documents in the belongings of the 26-year-old suspect indicating anger at the industry.

In the days immediately after the killing, NYPD reported that the terms “delay, deny and depose” were marked on bullet cartridges found at the scene of the shooting. Those terms are close to a phrase often associated with tactics used by insurers to avoid paying claims.

It’s a complicated issue for consumers and insurers. Denying claims and requiring pre-authorization for certain medical procedures are among the tools that health insurers use to block unnecessary or limited value care while restraining overall costs.

U.S. health care spending has been spiraling, with an expected 54% jump in expenditures to $7.7 trillion by 2032 from $5 trillion in 2024, according to the Centers for Medicare & Medicaid Services.

But critics of the health insurance industry say that some cost-saving policies have gone too far.

A U.S. Senate Permanent Subcommittee report in October on the biggest for-profit insurers providing Medicare benefits found, “Medicare Advantage insurers are intentionally targeting a costly but critical area of medicine — substituting judgment about medical necessity with a calculation about financial gain” in making decisions about care.

Prior authorization — getting an insurer's approval for coverage of a nursing home stay, for example — was once unusual, with only 5% of workers nationwide covered by such requirements in 1984, the report found.

By 2022, Medicare Advantage insurers received more than 46 million requests for prior authorization for care, and either fully or partially denied about 3.4 million of them, or about 7.4%, the report said.

“While prior authorization is not a verdict on what course of treatment a patient must pursue, a denial often forces a patient to either pay for the service out of pocket — if they can afford it — or forgo it entirely,” according to the report.

Independent insurance broker Joe Weinkle, of Wilkins Township, said claim denials have been less of a problem in southwestern Pennsylvania than other parts of the country.

“For the most part, it's a seamless process,” Weinkle, a broker for 51 years, said about filing claims with health insurers for payment of medical expenses. “Are there ever problems? Sure, there are. Are they as rampant as other places? I don't think so.”

Although the subcommittee's report focused on Medicare Advantage plans and admissions to treatment facilities after hospitalization, rising claim denial rates have been reported in other health insurance lines.

In Pennsylvania's online health insurance marketplace, called Pennie, 15.5 million claims were filed in 2023, with 13.8% of those requests for payment denied by insurers, according to a new report by the state Insurance Department.

That’s up from 12.6% in 2020 — a 9.2% rise in rejected claims in three years. Consumers appealed only 3,156, or less than 1% of those rejections, with insurers in 2023.

Meanwhile, Gov. Josh Shapiro decried efforts to make the suspect in the early morning shooting on a Manhattan sidewalk into a hero.

“I understand people have real frustration with our health care system,” he said at a news conference Monday in Altoona after Mangione’s arrest. “This killer is not a hero. He should not be hailed.”