News | Claims Adjudication

UnitedHealthcare reverses course on new approach to emergency department claims, but perhaps only temporarily

News | Claims Adjudication

UnitedHealthcare reverses course on new approach to emergency department claims, but perhaps only temporarily

  • UnitedHealthcare will wait at least until the end of the public health emergency before implementing new processes for assessing emergency department claims.
  • Under the original plans, the insurer would have denied claims starting July 1 for ED care that it deemed to have been nonemergent.
  • Provider associations continue to express significant concerns about the planned policy.

In the face of opposition from providers, UnitedHealthcare on June 10 backed off from its recently announced plan to assess emergency department (ED) claims more stringently.

The respite for members and provider partners may be only temporary, however. UHC says the delay will be in effect “at least” for the duration of the COVID-19 public health emergency.

UHC, the nation’s leading commercial health insurer by market share, had announced this week that it would evaluate claims starting July 1 to determine whether an ED visit was for an emergent or nonemergent event. Cases in the latter category would be covered only partially or not at all. A UHC spokesperson estimated that coverage would be denied for 10% of ED visits in accordance with the new policy.

As of the late afternoon of June 9, the planned policy was still on track, with the spokesperson touting the benefits while speaking on background to HFMA in a short interview.

But on the morning of June 10, UHC sent out tweets in which it announced the delay in implementation.

“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 nonemergency care needs,” according to the company’s Twitter feed.

Providers push for further accommodations

Strong pushback to the impending policy had come from the American Hospital Association and American College of Emergency Physicians, among other groups.

In response to Thursday's postponement, AHA issued a follow-up statement from President and CEO Rick Pollack, who called for the reversal to be made permanent.

“If enacted, this policy would have a chilling effect on patients seeking emergency services, with potentially dire consequences for their health,” Pollack wrote. “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. There is no justification for these restrictions now or after the public health emergency.”

The Federation of American Hospitals expressed similar sentiments in a letter from President and CEO Chip Kahn.

“While the delay is appreciated, this temporary pause does not address the underlying policy that poses harmful and unnecessary risk to patients, regardless of its date of implementation,” Kahn wrote. “Therefore, we urge you to immediately and permanently rescind this policy in order for your members to be assured that they will not be inhibited from seeking essential healthcare services.”

Related article: Looming UnitedHealthcare policy on coverage of emergency department care draws opposition from hospitals, physicians

About the Author

Nick Hut

is a senior editor with HFMA, Westchester, Ill. (nhut@hfma.org).

Sign up for a free guest account and get access to five free articles every month.

Advertisements

Related Articles | Claims Adjudication

Blog | Medicare Payment and Reimbursement

Coverage denials based on medical necessity are far more likely to arise from Medicare FFS rules than from MA plan policies

Coverage rules stemming from Medicare national and local determinations were the most likely cause of claim denials in one Medicare Advantage plan.

Blog | Administrative Simplification

Research highlights ways to save more than $250 billion per year through healthcare administrative simplification

Savings can be generated at the organizational and healthcare industry levels through steps to reduce wasteful administrative processes, study authors wrote.

Blog | Claims Adjudication

Hospital groups express concern over earlier court ruling that could expand False Claims Act liability

The groups argue that allowing FCA claims to be brought for post-termination actions would defy congressional intent and leave hospitals subject to excessive financial liability.

Blog | Coding

AMA releases 2022 CPT code set with new options that apply to COVID-19 vaccination, digital care services and more

The new set features more than 400 CPT code changes from 2021.