facebook linkedin twitter

UnitedHealthcare to Delay Emergency Visit Coverage Denials Amid Furor

June 16, 2021 by Reece Nations

MINNETONKA, Minn. — UnitedHealthcare announced it would delay plans to implement policy changes that would retroactively deny emergency medical care coverage to its customers if the company determines the reason for the care does not qualify as an emergency.

Initially set to take effect on July 1, UHC’s policy change would have the company review what health issues led its customers to file claims for an emergency department visit. Should UHC make the determination in its review that the “intensity of diagnostic services performed” did not merit emergency care, it will issue “no coverage or limited coverage” depending on the patient’s insurance plan.

“Based on feedback from our provider partners and medical societies, we have decided to delay the implementation of our emergency department program until at least the end of the national public health emergency period,” UHC announced in a written statement. “We will use this time to continue to educate consumers, customers and providers on the new program and help ensure that people visit an appropriate site of service for non-emergency care needs.”

Prior to the delay, UHC’s announcement was met with condemnation and outcry from hospital and doctor groups, such as the American College of Emergency Physicians. ACEP characterized the decision as “dangerous” and as a violation of the “Prudent Layperson Standard,” a federal policy that requires insurance companies to provide emergency care coverage based on the patient’s presenting symptoms rather than their final diagnosis.

Just 3% of emergency visits are determined to be “non-urgent” upon evaluation, and 90% of patient symptoms overlap between non-urgent and emergency conditions, according to Centers for Disease Control and Prevention data.

With a customer base of 70 million people and a care network of over 1.3 million physicians and health care professionals, UHC is the largest health insurer in the United States.

“While we’re dismayed by United’s decision, we are not, unfortunately, surprised to see an insurance company once again try to cut its costs at the expense of necessary patient care,” Dr. Mark Rosenberg, president of ACEP, said in a written statement. “UnitedHealthcare is expecting patients to self-diagnose a potential medical emergency before seeing a physician, and then punishing them financially if they are incorrect.”

Rosenberg continued, “Over the past year, we’ve seen the devastating impact of when patients avoid treatment — including worsening health conditions and even death. This new policy will leave millions fearful of seeking medical care, just as we’re getting hold of the COVID-19 pandemic and trying to get as many people vaccinated as possible.”

In an analysis published by JAMA Network Open in 2018, researchers examined whether a patient’s symptoms presented to the emergency department could be reliably designated as “non-emergency” based on the discharge diagnosis. In their findings, researchers found there was no way for physicians to make an accurate determination of the medical necessity for emergency care in advance.

The analysis was conducted and published by the JAMA Network when Anthem, the nation’s second-largest medical insurance provider by total members, began denying coverage after instituting a similar policy to UHC’s that year. Anthem’s policy change was met by a federal lawsuit by emergency room physicians, and the company eventually decided not to enforce the change despite never officially rolling it back.

“I’ve taken care of people with ‘indigestion’ who had heart attacks,” Dr. Megan Ranney, director of the Brown-Lifespan Center for Digital Health and cofounder of AFFIRM Research, said on Twitter. “People with ‘pink eye’ who had vision-threatening infections. [People] with a ‘tension headache’ who had [a] brain bleed. This policy is horrible. Patients shouldn’t be forced to decide if they’re having an ‘emergency.’” 

Health

October 27, 2021
by Alexa Hornbeck
How Horror Films Help Individuals Cope With Scary Situations

WASHINGTON — A study funded by the Research Program for Media, Communication, and Society at the School of Communication and... Read More

WASHINGTON — A study funded by the Research Program for Media, Communication, and Society at the School of Communication and Culture at Aarhus University in Denmark reveals how watching horror films may have helped individuals cope and prepare for the psychological distress of the COVID-19 pandemic.... Read More

October 27, 2021
by Alexa Hornbeck
Can Psychedelic Treatments Help People Quit Smoking?

WASHINGTON — The National Institutes of Health recently awarded a $4 million grant to Johns Hopkins Medicine for a three-year... Read More

WASHINGTON — The National Institutes of Health recently awarded a $4 million grant to Johns Hopkins Medicine for a three-year clinical trial to examine if psilocybin-assisted psychotherapies can help people quit smoking. “Psychedelic treatments ... when properly applied can help people get to the roots of... Read More

October 27, 2021
by Alexa Hornbeck
Letter Urges Passage of National Paid Leave to Combat Drug Addiction

WASHINGTON — When Khrista Messinger, a 46-year-old who works for the City of Charleston, W.Va., requested time off from work... Read More

WASHINGTON — When Khrista Messinger, a 46-year-old who works for the City of Charleston, W.Va., requested time off from work to seek treatment for her substance abuse addiction she was told by her employer that she needed to use her sick leave and vacation time. “I’ve... Read More

COVID Cases Falling, But Trouble Signs Arise as Winter Looms

Tumbling COVID-19 case counts have some schools around the U.S. considering relaxing their mask rules, but deaths nationally have been... Read More

Tumbling COVID-19 case counts have some schools around the U.S. considering relaxing their mask rules, but deaths nationally have been ticking up over the past few weeks, some rural hospitals are showing signs of strain, and cold weather is setting in. The number of new cases... Read More

October 20, 2021
by Dan McCue
FDA Signs Off on Moderna, J&J Boosters, Mixing Vaccines

WASHINGTON - The Food and Drug Administration on Wednesday said Americans who got either the Moderna or Johnson & Johnson... Read More

WASHINGTON - The Food and Drug Administration on Wednesday said Americans who got either the Moderna or Johnson & Johnson vaccine can now get a COVID-19 booster, and also say that those eligible for a booster don’t have to get the same brand as their initial... Read More

October 20, 2021
by Alexa Hornbeck
EPA Accelerates Efforts to Clean Up PFAS Pollution

This week, the Environmental Protection Agency released a new roadmap to accelerate efforts to protect Americans from per- and polyfluoroalkyl... Read More

This week, the Environmental Protection Agency released a new roadmap to accelerate efforts to protect Americans from per- and polyfluoroalkyl substances, a class of toxic chemicals found in food packaging and other common commercial products that can cause severe health problems. "We are exploring ways for... Read More

News From The Well
scroll top