Insurance giant's new ER policy called 'dangerous' by critics. It says as many as 1 in 10 claims could be rejected.
Jun 10, 2021 1 min, 57 secs
Here's how your health savings account can be used for more than emergency room visits.

Insurance giant UnitedHealthcare is cracking down on emergency room visits with a new policy starting July 1 that the American Hospital Association says will jeopardize patients’ health and threaten them with financial penalties.

The American College of Emergency Physicians said it fears the change will cause patients to avoid using emergency rooms because they will be responsible for their hospital bills when UnitedHealthcare rejects them.

UnitedHealthcare this month told its network hospitals in 34 states  that it will assess emergency room claims to determine if visits were indeed medical emergencies.

“If the event is determined to not be an emergency, the claim will be paid based on the member’s benefits,” Lempner said, adding, “We estimate that nationally less than 10% of (Emergency Department) claims will be classified as non-emergent through this program.”.

The policy applies to the hospital portion of emergency room care, so patients could be billed when the claim is denied, said Laura Wooster, associate executive director of public affairs for the emergency physicians organization, based in Washington, D.C.

Steve Zucker/News-ReviewUnlike the big red letters leading the way to McLaren Northern Michigan hospital's emergency department, it isn't always easy to read when a health condition calls for a trip to the emergency room.

This is not the first time that insurers have adopted policies to deny claims from emergency rooms, often the costliest source of medical care.

Lempner said unnecessary use of emergency rooms cost $32 billion annually and drives up health care costs for everyone.

“We are taking steps to make care more affordable, encouraging people who do not have a health care emergency to seek treatment in a more appropriate setting, such as an urgent care center,” she said.

According to the Centers for Disease Control and Prevention, 3% of emergency room visits are nonurgent, the emergency physicians group said

With 90% of symptoms overlapping between non-urgent and emergent conditions, in many instances even physicians cannot know if a patient’s symptoms require emergency treatment without conducting a comprehensive medical examination, the physicians group said

UnitedHealthcare’s new policy is more detrimental to patients than the one adopted by Anthem in 2018 in many states that led the emergency physicians group to file the lawsuit against Anthem that is still pending, said Wooster of the physicians group


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