Sloan Dickey, Denver7
DENVER — Less than 24 hours after its announcement, UnitedHealthcare has postponed a policy it says would more heavily scrutinize emergency room visits. The postponement comes after intense pushback from health care advocates who say the policy could have a chilling effect on patients using emergency care for legitimate concerns.
“We have made the decision to delay implementation. Based on feedback from our provider partners and discussions with medical societies, we have decided to delay the implementation of our emergency department policy until at least the end of the national public health emergency period,” the company told Denver7 in a statement.
The policy, which was originally set to go into effect in July, intends to crack down on “non-emergent” visits to emergency rooms. According to a 2019 study, the avoidable visits cost the health care industry roughly $32 billion dollars every year.
“Claims determined to be non-emergent will be subject to no coverage or limited coverage in accordance with the member’s Certificate of Coverage,” a letter to hospitals from UnitedHealthcare states. “This enhanced capability will apply to commercial fully insured (Emergency Department) facility claims in many states for dates of service on July 1, 2021, or later.”
The July 1 date has been pushed back by UHC. The company says it “will use this time to continue to educate consumers, customers and providers on the new policy and help ensure that people visit an appropriate site of service for non-emergency care needs.”
But some advocates say the policy should be vetoed completely.
“While it’s a relief that patients will get a short-term reprieve, United is not getting rid of this dangerous policy—only delaying it,” Laura Wooster, a Director of Public Affairs for the American College of Emergency Physicians, said in a statement. “Medical emergencies will continue to happen beyond the pandemic.”
The American Hospital Association has similar concerns and is calling for a reversal of the policy.
“If enacted, this policy would have a chilling effect on patients seeking emergency services, with potentially dire consequences for their health,” American Hospital Association President Rick Pollack said in a statement. “Patients should have the confidence to seek the emergency care they need without worrying about coverage being denied.”
Patient advocates say the policy could lead to UnitedHealthcare retroactively canceling coverage for medical procedures they deem unnecessary.
“It makes the assumption that all consumers can have the choice of not going to the ER and going to other lower-intensity sources of care—whether that’s a primary care doc or urgent care,” said Adam Fox, the deputy director of the Colorado Consumer Health Initiative. “That’s not a fair assumption.”
United Healthcare has not given a specific date for when the policy will take effect, only saying that it will be “until at least the end of the national public health emergency period.”
Medical professionals say it is important for patients to find the correct care whether they have insurance or not.
“It’s important to note the place you’re going to go and what their capabilities are, who will be seeing you and what they can actually do,” said Dr. Eric Hill, the EMS Medical Director at the Medical Center of Aurora. He says the emergency room is expensive because it is “a 24/7service, and because it can literally bring anything to bear to manage a situation.”
He also says it is important if you have insurance to establish a connection with a primary care doctor to avoid potentially expensive emergency room visits if they are not necessary.
“Surprisingly enough, a lot of people that have insurance have never actually established a primary care doctor because otherwise feel healthy,” explained Hill. “Once you’re an established patient, you can typically get in much quicker for urgent needs. And you usually have an on call physician that will take your phone call.”