UnitedHealthcare May Deny Emergency Visit Coverage

UnitedHealthcare May Deny Emergency Visit Coverage

UnitedHealthcare May Deny Emergency Visit Coverage

UnitedHealthcare May Deny Emergency Visit Coverage

“Unnecessary use of the emergency room costs nearly $32 billion annually, driving up health care costs for everyone,” the company said in a statement on Monday. “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. If one of our members does receive care in an emergency room for a t issue, like pink eye, we will reimburse the emergency facility according to the member’s benefit plan.”

During the pandemic and for months of lockdown, non-Covid care, ranging from knee surgeries to mammograms to emergency room visits, fell. While some experts worried that the lack of care would cause patients’ conditions to worsen, others argued the drop off might provide evidence that some care, like screenings, was unnecessary.

United’s initial decision was viewed by some critics as a message directed at hospitals.

“They see this as a way to get the upper hand in their perpetual battle with providers,” said Jonathan Kolstad, a health economist at the University of California, Berkeley.

It was the latest example of the insurer clashing with doctors and hospitals, said Michael R. Turpin, a former United executive who is now an executive vice president at USI, an insurance brokerage that helps businesses find coverage. Most recently, United’s sparring with anesthesiologists resulted in lawsuits from a sizable physician-owned practice backed by private-equity investors, and the hospitals complain that United has adopted other policies that make it difficult for patients to get their care covered.

A few consumers are already battling insurers and some providers over billing for Covid vaccines, prompting the federal government to remind the participants that it is illegal to bill patients for those costs.

There is also increasing evidence that some of the people who didn’t go to emergency rooms during the pandemic would have been better off seeking care. Experts pointed to the increase in death rates from heart disease, diabetes and other illnesses that could indicate people were putting off necessary care. A recent study in Health Affairs by researchers from the M.I.T. Sloan School of Management, working with Boston Emergency Medical Services, found evidence of an increase in heart attacks that had occurred out of the hospital, particularly in low-income neighborhoods.

Mr. Pollack noted that even post-pandemic, such a policy would be problematic: “There is no justification for these restrictions now or after the public health emergency,” he said.


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