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United Healthcare delays new ER visit policy based on feedback

Emergency Rooms
Posted at 12:10 PM, Jun 10, 2021
and last updated 2021-06-10 19:55:29-04

UnitedHealthcare has decided to delay the implementation of a new policy that would reduce coverage, or stop payment, for patients' non-emergency visits to an emergency room.

The change was announced earlier this week and was originally supposed to go into effect July 1. The plan received swift backlash from health experts and patient advocacy groups.

The American College of Emergency Physicians, said the new policy would "leave millions fearful of seeking medical care."

“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,” said Mark Rosenberg, DO, MBA, FACEP, president of ACEP, in a news release. “UnitedHealthcare is expecting patients to self-diagnose a potential medical emergency before seeing a physician, and then punishing them financially if they are incorrect.”

The insurance giant said they'll evaluate claims based on factors, including the patient’s presenting problem, the services performed, and other factors.

If the claims are determined not to be emergent, they'll be subject to no coverage or limited coverage based on the patient's plan.

The insurance company said if the visit is determined to be non-emergent, providers will need to complete an attestation to challenge it.

A spokesperson for UnitedHealthcare told USA Today that as many as 1 in 10 claims could be rejected.

Thursday, UnitedHealthcare issued a statement saying it will delay the start of the new policy.

"We have made the decision to delay implementation. 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.”
-UnitedHealthcare