Source: USAToday
Read more: https://www.usatoday.com/story/news/hea ... 629006002/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 including Florida that it will assess emergency room claims to determine if visits were indeed medical emergencies. Claims that are determined not to be tied to emergencies will be subject to no coverage or limited coverage based on the patient’s insurance plan, according to the insurer’s notice sent to hospitals. As many as 1 in 10 claims could be rejected, said Tracey Lempner, spokeswoman for the Minnesota-based insurer.
UnitedHealthcare’s policy affects commercially insured patients with employer-sponsored plans and does not apply to patients with Medicare Advantage or contracted Medicaid coverage with UnitedHealthcare, Lempner said. UnitedHealthcare in 2018 said it had more than 30 million Americans with commercial or employer-sponsored plans. “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 will take effect in 34 states and the District of Columbia, Lempner said. They are: Alabama, Arizona, Arkansas, Colorado, Connecticut, Washington, D.C., Delaware, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia and Wisconsin.