The suspect in the shooting death of the UnitedHealthcare CEO, Brian Thompson, screamed: “This is completely out of touch and an insult to the intelligence of the American people” on Tuesday before he fought being extradited from Pennsylvania to face murder charges in New York.

During the hearing, beside choosing to fight his extradition, Luigi Mangione was denied bail. For now, Mangione, 26, will return to custody at Pennsylvania’s Huntingdon state correctional institution while navigating the process to contest extradition, which could take days – if not a month or more, as the New York Times noted.

Mangione appeared for the proceeding in handcuffs and an orange prison jumpsuit, and video showed him yelling as police led him into the courthouse. Not all of what he screamed was immediately intelligible.

Mangione was arrested on Monday at a McDonald’s restaurant in Altoona, Pennsylvania, in connection with Thompson’s killing outside a Manhattan hotel hosting a meeting of investors in the CEO’s company.

The authorities in Pennsylvania detained him after being recognized by a local person from photographs released by New York police investigating the murder.

Police found Mangione with a firearm suppressor, a mask like the gunman’s, a fake New Jersey ID matching the one the police say the gunman used to check into the New York City hostel before the shooting, and a handwritten document, according to New York authorities.

On Monday night, Mangione was charged with second-degree murder, forgery and three gun charges by prosecutors in New York, following his arraignment at the Blair county courthouse in Altoona, Pennsylvania, where he faces separate charges of carrying a gun without a license, forgery, falsely identifying himself to the authorities and possessing “instruments of crime”.

During the arraignment hearing Monday, the judge asked Mangione if he understood the charges against him, and he said he did. No plea was entered and he was denied bail.

As detectives begin piecing together Mangione’s history, one area of focus has been the chronic back problems that he appears to have suffered since childhood.

Investigators could explore whether Mangione was denied insurance coverage for his condition.

He also appears to have withdrawn from social connections months earlier, prompting one to write on social media: “I don’t know if you are ok or just in a super isolated place … but I haven’t heard from you in months.”

The Mangione family released a statement on Monday evening, stating that the family was “shocked and devastated by Luigi’s arrest”.

“We offer our prayers to the family of Brian Thompson, and we ask people to pray for all involved,” they added.

Among other things, Mangione is entitled to an evidentiary hearing in Pennsylvania after his decision to fight extradition. And prosecutors will also have to summon at least one witness, which could give the public a closer look at the case that it otherwise may not receive.

As also noted by the New York Times, the office of New York governor Kathy Hochul will be required to submit what is known as a governor’s warrant to her Pennsylvania counterpart Josh Shapiro to formally request extradition before the process begins in earnest.