June 11, 2021
Minneapolis-based insurance giant UnitedHealthcare is cracking down on emergency room visits with a new policy starting July 1 that the American Hospital Association says will jeopardize patients’ health and threaten them with financial penalties, reports the Naples Daily News.
The American College of Emergency Physicians said it fears the change will cause patients to avoid using emergency rooms because they will be responsible for their hospital bills when UnitedHealthcare rejects them.
UnitedHealthcare this month told its network hospitals in 34 states that it will assess emergency room claims to determine if visits are, in fact, medical emergencies.
Claims that are determined not to be tied to emergencies will be subject to no coverage or limited coverage. based on the patient’s insurance plan, according to the insurer’s notice sent to hospitals. As many as 1 in 10 claims could be rejected, said Tracey Lempner, spokesperson for the insurer.
UnitedHealthcare’s policy affects commercially insured patients with employer-sponsored plans and does not apply to patients with Medicare Advantage or contracted Medicaid coverage with UnitedHealthcare, Lempner said.
The policy will take effect in 34 states and the District of Columbia, Lempner said. Included among them are Alabama, Arizona, Arkansas, Colorado, Connecticut, Washington, D.C., Delaware, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia and Wisconsin.
The policy applies to the hospital portion of emergency room care, so patients could be billed when the claim is denied, said Laura Wooster, associate executive director of Public Affairs for the American College of Emergency Physicians, based in Washington, D.C.
“If United doesn’t cover it, then the patient will be on the hook,” she said. “It looks like they are not on the hook for the (emergency physicians’ bill). We are trying to get more information on that.”
She could not say whether other insurers will adopt a similar policy.
Research contact: @ndn
Editor’s Note: In the face of growing opposition from hospital and doctors groups, UnitedHealthcare said on Thursday it would delay its plan to stop paying for emergency room visits that it deemed nonurgent, at least until the pandemic has ended.