UnitedHealthcare plans to reduce coverage, or stop paying for, patients' non-emergency visits to the emergency room with a new policy that goes into effect on July 1.
Published June 9, 2021
Dive Brief:
The American Hospital Association sent a letter to the CEO of the nation s largest commercial insurer, UnitedHealthcare, asking the payer to abandon a new ER policy that could potentially deny coverage if a visit is later deemed a non-emergency.
AHA called the policy dangerous and said it will lead to a chilling effect, as patients may avoid the ER over fears a visit may not be covered.
The group did not explicitly say UnitedHealthcare is not following the law, but implied as much. This is exactly why federal law requires insurers to adhere to the prudent layperson standard, which prohibits insurers from putting up coverage roadblocks to emergency services, AHA said in the Tuesday letter to UnitedHealthcare CEO Brian Thompsom.
New UnitedHealthcare policy allows insurer to retroactively deny ER claims Wednesday, June 9, 2021 3:06 PM Hospitals and physicians are condemning a new UnitedHealthcare policy under which the insurer may retroactively deny some emergency department claims, Fierce Healthcare reported. Effective July 1 across most states, UnitedHealthcare, the largest U.S. health insurer, may not fully cover an emergency room visit for its commercial members if it determines that their condition didn t warrant a trip to the ER. It s similar to a policy Anthem has in place for emergency room care. In a June 8 letter to UnitedHealthcare s CEO Brian Thompson, American Hospital Association CEO Rick Pollack wrote that the new policy would jeopardize patient care and should be immediately reversed. Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency. Threatening patients with a financial penalty for