UnitedHealthcare delays controversial new ER policy

by | Jun 11, 2021

After harsh criticism from the medical community, UnitedHealthcare announced Thursday it is delaying a new emergency department policy in which the insurance provider would stop paying for emergency room (ER) visits it deemed not to be true emergencies.

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

Earlier this month, UnitedHealthcare told its network hospitals in 34 states including Florida that, beginning July 1, it would scrutinize emergency room claims to determine whether the visits were emergent or non-emergent. Claims determined to be non-emergent would be subject to no coverage or limited coverage.

This caused an outcry from those in the medical industry who are already dealing with sharp declines in ER visits due to lingering fears of the coronavirus. Hospitals and doctors are worried of the health consequences of patients continuing to delay needed care, of patients ignoring the warning signs of heart attacks and strokes and delaying necessary health screenings.

The American Medical Association President Dr. Susan R. Bailey said in a statement to the New York Times, “We object to UnitedHealthcare’s pending policy that asks patients to second guess their instincts that emergency care is needed. Patients should not be expected to self-diagnose to determine whether, for example, chest pain is a heart attack or indigestion.”

While the delay is a welcomed first step, major hospital and doctors’ groups are seeking the complete repeal of the policy.

Upon hearing of the insurer’s decision, the Florida Medical Association tweeted, “Thankfully, UHC has postponed its dangerous initiative to stop paying for ER visits that the company deems non-emergent. The FMA welcomes this decision & urges UHC to suspend its implementation permanently. This is a bad policy that puts the lives of vulnerable patients at risk.”

The American Hospital Association CEO Rick Pollack urged a “full and permanent reversal” of a policy he called “very misguided,” particularly during the pandemic.

“Deferred and delayed care during the pandemic has already contributed to adverse health conditions and increased acuity,” Pollack wrote in a letter to UnitedHealthcare’s chief executive.

In defense of the policy, UnitedHealthcare spokeswoman Tracey Lempner, said unnecessary use of emergency rooms cost $32 billion annually and drives up health care costs for everyone.

“We are taking steps to make care more affordable, encouraging people who do not have a health care emergency to seek treatment in a more appropriate setting, such as an urgent care center,” she said.


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