UnitedHealthcare delays new ED claims denial policy

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UnitedHealthcare on Thursday said it will delay implementing its new policy that would retroactively deny patients’ claims of emergency department visits that are considered non-emergent.

The insurer stated in a tweet that it has decided to wait on the policy until “at least the end of the national public health emergency period” due to feedback from its provider partners and conversations with various medical societies.

UnitedHealthcare planned to start reviewing its approximately 26.3 million commercial patient ED visits more carefully starting July 1. Those visits cost $32 billion annually. Anthem issued a similar policy in 2017, which also received backlash.

Policymakers and providers said that the policy would be illegal under the prudent layperson standard, and could deter patients from going to the emergency department, a dangerous outcome during the COVID-19 pandemic.

In a statement, American Hospital Association President and CEO Rick Pollack said while the delay “offers a temporary reprieve for patients,” UnitedHealthcare should permanently reverse the policy.

“Patients should have the confidence to seek the emergency care they need without worrying about coverage being denied,” Pollack said. “There is no justification for these restrictions now or after the public health emergency.”

Nathan Seth Trueger, emergency physician at Northwestern Medicine, said while it is great that the backlash has caused UnitedHealthcare to pause its policy, the message has gotten out and patients will likely still be unsure about seeking emergency care.

“[The policy has] two main goals,” Trueger said. “One, is to get patients to question whether or not they should go to the ED, so that insurers don’t have to pay in the first place. And two, is to push the administrative burden onto the patients and doctors so that [the insurer] can start denying more claims … and at some point the hassle is just not worth getting the payment for the services or getting the coverage from the carrier.”

Trueger said one of the main reasons patients go to the ED is because they don’t have other options when insurance companies don’t have a big enough network filled with primary care providers who have enough time for unscheduled care, especially after hours.

Ari Gottlieb, principal at A2 Strategy, said the public response seems like preemptive outrage over the policy since it has has not been implemented yet and does not appear to be something that would limit patients’ access to care.

Gottlieb said UnitedHealthcare likely backed off so quickly because out of the trillions spent on healthcare, non-emergency related ED visits don’t amount to much.

“If this actually did have the potential for substantial savings, [UnitedHealthcare] probably would have fought back,” Gottlieb said. “But this feels like one of those normal adjustments to policy that maybe will save a couple $100,000 or a couple million dollars a year in a particular state, which is really not that significant.”

UnitedHealthcare said until it unveils the policy, it will continue educating consumers, customers and providers on what the policy entails and help people find an appropriate site of service for non-emergent care.

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