Insurance claim denial

UHC to Deny Claims for “Non-Emergencies”

The US’ largest health insurer, UnitedHealthcare, is delaying a controversial new policy. Emergency room visits considered “non-emergent” may be partially or fully denied coverage. The policy to deny claims was set to go into effect on July 1. However, UHC is now delaying implementation at least until the pandemic is over.

American Hospital Association president Richard Pollack rebuked the plan in a public letter to UHC’s CEO. He noted “patients… should not be expected to self-diagnose during what they believe is a medical emergency.” Pollack said the AHA is “deeply concerned” by the policy. Likewise, the American College of Emergency Physicians “strongly condemns” the decision to deny claims.

For its part, UHC explained the plan as an attempt to bring down the costs of healthcare. It told Fierce Healthcare that “Unnecessary use of the emergency room costs nearly $32 billion annually.” The AHA pointed out, however, that UHC’s premiums and profits are rising. ACEP’s president Mark Rosenberg said the organization was “dismayed by United’s decision” but “not, unfortunately, surprised.”

Anthem, Inc. instituted a similar policy in 2018 and faced its own backlash once it began to deny claims. The insurer eventually rolled back its version after denials were challenged. UHC may well back down, too. Patients, practices, and medical billers will all push back on this policy. The AHA suggested that providing better non-urgent access and coverage could reduce healthcare costs. It further noted that UnitedHealth Group earned $6.7 billion in Q1 2021.

Ultimately, emergency doctors and hospitals are worried that patients will second-guess their emergency needs. Concern that the carrier will deny claims could lead to critical treatment being delayed or even avoided. Even announcing the policy without implementing it yet could discourage ER visits. The long-term effects of this decision remain to be seen.

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