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Force UnitedHealthcare yells at plans to delay denial of coverage for some ER visits


“Unnecessary use of emergency rooms costs approximately $32 billion annually, increasing health care costs for all,” the company said in a statement on Monday. “We are taking steps to make care more affordable, encouraging people who do not have health care emergencies to seek treatment in a more appropriate setting, such as an urgent care center. If our If one of the members receives emergency room care for a problem such as pink eye, we will reimburse the emergency facility according to the member’s benefit plan.

During the pandemic and months of lockdown, non-Covid care has plummeted, from knee surgery to mammograms to emergency room visits. While some experts worried that the lack of care would make patients’ conditions worse, others argued that the drop off could provide evidence that some care, such as screening, was unnecessary.

United’s initial decision was seen by some critics as a message to hospitals.

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

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

some consumers are already struggling On billing insurers and some providers for COVID vaccines, prompting the federal government to remind participants that it is illegal to bill patients for those costs.

There is also increasing evidence that some people who did not go to emergency rooms during the pandemic would be better off seeking care. Experts pointed to an increase in death rates from heart disease, diabetes and other diseases that could indicate that people are putting off essential care. a recent study Health Affairs by researchers at the MIT Sloan School of Management working with Boston Emergency Medical Services found evidence of an increase in out-of-hospital heart attacks, especially in low-income neighborhoods.

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



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