American Hospitals Association says insurance giant UnitedHealthCare is launching emergency room visits with a new policy effective July 1 that will harm patients health and threaten to punish them.
American College of Emergency Physicians said they feared the change would prevent patients from using emergency rooms because they would be liable for hospital bills if United Health Care refused them.
UnitedHealthCare told network hospitals in 34 states this month that it would review emergency room claims to see if there was a real medical emergency.
Claims not related to emergencies cannot be forwarded to hospitals on the basis of the insurer's notice, subject to no insurance or limited coverage under the patient's insurance plan. Tracy Lampner, a spokeswoman for the Minnesota-based insurer, said 1 in 10 claims could be denied.
Lepner says UnitedHealthCare's policies affect patients who are insured commercially with employer-sponsored plans and do not apply to patients with Medicare Advantage or Medicaid coverage contracted with UnitedHealthCare.
UnitedHealthCare reported in 2018 that it has more than 30 million Americans, including commercial or employer-sponsored plans.
If the event is scheduled as an emergency, the claim will be paid for the benefit of the member, Lampner said, adding: "We estimate that less than 10% of claims will be classified nationally (from the emergency department) that did not emerge as this program."
The policy will apply to 34 states and the District of Columbia, Lampner said. They are Alabama, Arizona, Arkansas, Colorado, Connecticut, Washington DC, Delaware, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, New York, Mississippi, New York , Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia and Wisconsin
Laura Wester, assistant executive director of public affairs at the Emergency Medical Association in Washington, D.C., said the policy applies to parts of the emergency home care hospital, so patients can be billed if the claim is denied.
If United doesn’t cover it, the patient will hang on, he said. It seems that these were not included in the emergency medical bills. We are trying to get more information about it.
He could not say whether other insurers would adopt a similar policy.
I’m sure they’ll see him, he said.
This is not the first time that insurance providers have adopted a policy of denying claims from emergency rooms, which are often the most expensive source of medical care.
Indianapolis-based Anthem adopted a similar policy in 2018 that is subject to litigation on behalf of a team of emergency physicians, he said. And UnitedHealth Care began reducing emergency housing claims in 2018 when it determined that encryption was inappropriate.
The American Hospitals Association has called on United Healthcare to withdraw the new policy immediately, President and CEO Richard Pollack said in a June 7 letter to insurers.
The insurance company’s parent company, UnitedHealth Group, made $ .7 billion in the first quarter of the year, the hospital association said.
Pollack said in his letter that patients are not medical specialists and should not expect self-diagnosis when they believe treatment is urgent. Threatening patients with financial penalties for making the wrong decision can have a chilling effect on their search for emergency care.
The insurer's parent company, UnitedHealth Group, made $ 6.7 billion in the first quarter of the year, according to the hospital association.
"Patients are not medical experts and should not be expected to diagnose themselves during what they believe to be a medical emergency," Pollack said in his letter. “Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care.
According to the federal team of physicians, insurance companies take patients to the emergency room and require insurance companies to provide emergency home care based on the symptoms that are not present for final diagnosis.
"While we are disappointed with United's decision, unfortunately we are not surprised to see an insurance company again trying to reduce the cost of patient care," said Drs. Mark Rosenberg says the state of emergency. In a statement.
Rosenberg said: "UnitedHealthCare expects patients to self-diagnose a potential medical emergency before seeing any physician and even then if they do not pay, they are penalized financially."
According to the Centers for Disease Control and Prevention, 3% of emergency room visits are non-emergency, a team of emergency physicians said.
Since 90% of symptoms overlap between emergency-raised and emerging conditions, in many cases even physicians cannot tell whether a patient's symptoms require emergency treatment without a full medical examination, the team of doctors said.
United Health Care Lampner said the policy meets federal regulations and standards for the general public.
UnitedHealthcare's new policy is doing more harm to patients in the state that adopted anthem in 2018, which prompted a group of emergency physicians to file lawsuits against anthem that is still pending, said Oster of Physicians Group.
Anthem began to refuse to pay for emergency room services in a handful of states when the insured decided the member did not face any emergency. As a result, patients were stuck with the bill.
“They’ve basically been the opposite of that,” Oster says. "They are not applying it."
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