UnitedHealthcare's plan to retroactively deny emergency room coverage for emergency room visits it believes weren't actually an emergency is being put on hold.
Under the policy, originally set to go into effect July 1, the Minnesota-based healthcare giant planned to review emergency department claims to determine if the event "was emergent or non-emergent" – meaning, whether it was actually an emergency – according to plan provisions.
If UnitedHealthcare – the largest health insurer in the country – decided the patient went to the ER even though it wasn't emergency, coverage for the visit would be denied or limited, meaning patients would pay more out of pocket.
UnitedHealthcare argued the revised emergency department policy would lower health care costs for everyone by cutting out billions of dollars every year tied to unneeded ER visits, Med City News reported.
The policy sparked immediate backlash, with groups arguing it was actually about the bottom line of the health insurer – which recently posted 1st Quarter profits of $4.9 billion – at the cost of patient health and safety.
The American College of Emergency Physicians called it "dangerous," with its president, Mark Rosenberg, saying: “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."
And Richard Pollack, the president and CEO of the American Hospital Association, wrote an open letter in which he noted UnitedHealthcare's new policy "would put patients’ health and wellbeing in jeopardy" by discouraging patients from making ER visits.
"Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency," he wrote. "Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care."
Both Rosenberg and Pollack said the ongoing COVID-19 pandemic exacerbates these concerns.
In response, UnitedHealthcare announced it was delaying this new 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," the company said in its bulletin.