UHC Temporarily Reverses Emergency Department Coverage Policy

UnitedHealthcare (UHC) has announced it will delay its recent protocol change regarding emergency department (ED) claims and coverage, after receiving backlash from providers and health organizations alike.

“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,” the AskUHC Twitter account tweeted.

The policy, which was set to be implemented on July 1, 2021, would change how UHC evaluates ED visits. If an ED is ruled to be non-emergent, it would receive limited or no coverage from UHC.

UHC’s stated goal with the new protocol was to reduce emergency department costs by eliminating the overuse of EDs for primary care conditions. Primary care treatment cost at the emergency room was 12 times higher than the cost of the care at a physician’s office.

However, organizations like the American Hospital Association (AHA) voiced opposition to UHC’s new policy. AHA also called for the permanent reversal of the policy, following UHC’s original announcement.

“Today’s announcement from UnitedHealthcare to delay its new policy on emergency coverage offers a temporary reprieve for patients, and we urge its full and permanent reversal,” the statement read.

“If enacted, this policy would have a chilling effect on patients seeking emergency services, with potentially dire consequences for their health. It is also part of an unfortunate pattern of commercial health insurers denying care for needed services. Patients should have the confidence to seek the emergency care they need without worrying about coverage being denied.”

UHC plans to continue with the policy once the coronavirus public health emergency is over, however. Another AskUHC tweet read, “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.”

In the past, payers have faced legal action regarding the denial of emergency room cost coverage. Last August, Aetna was fined $500,000 by California’s Department of Managed Health Care.

Under California law, health plans are required to cover emergency room services unless the health plan can prove the procedure never took place or the patient’s condition was not an emergency and should have reasonably known it. The court found that 93 percent of the claims that Aetna denied should not have been denied under California law.