THE VALUED VOICE

Thursday, January 6, 2022

   

After Hospitals Push Back, United Clarifies ED Policy

No immediate changes in coverage for emergency care
After releasing a new policy bulletin in which UnitedHealthcare (UHC) provided vague criteria that would have allowed the company to deny coverage for care delivered in an emergency room, the insurer backtracked just before its scheduled implementation on Jan. 1. This followed several communications from the American Hospital Association urging UHC to reconsider. 
 
As previously reported, under the now rescinded policy, the insurance company would have taken into account the final diagnosis and “other pertinent information” in determining after the fact if a patient’s decision to go to the emergency department really was an emergency. Providers were particularly concerned with the term “other pertinent information,” which could have given the company significant latitude to deny coverage after the fact. This uncertainty would make patients reluctant to seek emergency care.   
 
In its response, UHC CEO Brian Thompson clearly stated, “there is no new policy regarding coverage criteria for emergency care being implemented on January 1, 2022.” He also wrote that the company “has no intention of implementing any such policy for its fully insured business.”

“We are pleased that UHC has issued a clarification on its policy. We hope that any future policy changes from the company are much more limited and take into account what is best for the patient, which is not to put up barriers for patients to seek and obtain the care they need,” said WHA Senior Vice President of Public Policy Joanne Alig.
 

This story originally appeared in the January 06, 2022 edition of WHA Newsletter

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Thursday, January 6, 2022

After Hospitals Push Back, United Clarifies ED Policy

No immediate changes in coverage for emergency care
After releasing a new policy bulletin in which UnitedHealthcare (UHC) provided vague criteria that would have allowed the company to deny coverage for care delivered in an emergency room, the insurer backtracked just before its scheduled implementation on Jan. 1. This followed several communications from the American Hospital Association urging UHC to reconsider. 
 
As previously reported, under the now rescinded policy, the insurance company would have taken into account the final diagnosis and “other pertinent information” in determining after the fact if a patient’s decision to go to the emergency department really was an emergency. Providers were particularly concerned with the term “other pertinent information,” which could have given the company significant latitude to deny coverage after the fact. This uncertainty would make patients reluctant to seek emergency care.   
 
In its response, UHC CEO Brian Thompson clearly stated, “there is no new policy regarding coverage criteria for emergency care being implemented on January 1, 2022.” He also wrote that the company “has no intention of implementing any such policy for its fully insured business.”

“We are pleased that UHC has issued a clarification on its policy. We hope that any future policy changes from the company are much more limited and take into account what is best for the patient, which is not to put up barriers for patients to seek and obtain the care they need,” said WHA Senior Vice President of Public Policy Joanne Alig.
 

This story originally appeared in the January 06, 2022 edition of WHA Newsletter