Archives     Advertise     Editorial Calendar      Advertiser Index     Subscribe     Contact Us    

UPDATE: UnitedHealthcare Policy on Emergency Coverage


Since AHA and ACEP both released statements in response to UnitedHealthcare's policy announcement that would allow for retroactive emergency-level care denials, the insurer has announced it would delay implementation. AHA released the following statement on 6/10/21 following UHC's announcement:

"Today's announcement from UnitedHealthcare to delay its new policy on emergency coverage offers a temporary reprieve for patients, and we urge its full and permanent reversal. If enacted, this policy would have a chilling effect on patients seeking emergency services, with potentially dire consequences for their health. It is also part of an unfortunate pattern of commercial health insurers denying care for needed services. Patients should have the confidence to seek the emergency care they need without worrying about coverage being denied. There is no justification for these restrictions now or after the public health emergency." - Rick Pollack, President & CEO, American Hospital Association

June 8, 2021

Brian Thompsom
Chief Executive Officer
P.O. Box 1459
Minneapolis, MN 55440-1459

Dear Mr. Thompson,

America's hospitals and health systems are deeply concerned by UnitedHealthcare's (UHC) recent policy announcement to allow for the retroactive denial of coverage for emergency-level care in facilities. This policy would put patients' health and wellbeing in jeopardy, and we urge you to reverse the policy immediately.

Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency. Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care. This is dangerous for patients' health at any time, but is particularly unsafe in the midst of a public health emergency. Deferred and delayed care during the pandemic has already contributed to adverse health conditions and increased acuity.1 This is exactly why federal law requires insurers to adhere to the prudent layperson standard, which prohibits insurers from putting up coverage roadblocks to emergency services, such as by determining retroactively whether a service will be covered based on the patient's final diagnosis.

UHC's own guidance to its enrollees regarding when to access emergency services is vague and could confuse patients, especially in light of this new policy. For example, one UHC webpage specifically tells enrollees: "Do not ignore an emergency. Take action if a situation seems life-threatening. Head to your nearest emergency room or call 9-1-1 or your local emergency number right away."2 That same webpage then over- generalizes symptoms that UHC suggests are appropriate for urgent care. This includes symptoms that could be signs of medical emergencies depending on the cause and severity, such as stomach pain, nausea, vomiting, diarrhea and abnormal vaginal bleeding.

UHC may believe inappropriate use of the emergency room is a widespread problem; however, there is limited evidence to support this view. Regardless, the policy brings potentially severe consequences and raises significant questions about the criteria UHC will use to determine emergency services coverage. For example, has UHC assessed whether its enrollees have enough providers available during non-traditional hours, such as evenings and weekends? Has it helped its enrollees connect with a primary care provider? Do its networks offer sufficient access to alternate sites of care, and will UHC cover the care provided at those sites without excessive administrative barriers? Also, can UHC confirm in writing that if the facility attests that a case met the prudent layperson standard that the services will be covered?

In addition, we also urge UHC to evaluate whether its other policies that restrict enrollees' coverage for a wide range of hospital outpatient department services may contribute to access challenges for patients. For example, UHC has announced policies that would reduce or eliminate coverage for certain hospital-based surgeries, laboratory and other diagnostic services, specialty pharmacy therapies, and evaluation and management services, including those provided in the emergency department, as well as those that constitute primary care. If UHC is successful in denying coverage for these services in hospital outpatient departments, it could exacerbate UHC's concerns regarding emergency department use.

UHC acknowledges that this policy change is financially-motivated and suggests that the savings associated with it will accrue to consumers.3 We question whether this is true. Despite implementing policies to restrict enrollee coverage over the past several years, UHC premiums continue to rise in most markets, as do UHC's profits. As you know, UHC's parent company UnitedHealth Group posted a 35% year-over-year jump in operating profits in the first quarter of 2021.4 Despite earning $6.7 billion in a single quarter, UHC enrollees are being asked to pay more for their coverage.

Individuals and families who purchase health insurance deserve reliable, worry-free coverage that meets their health care needs and complies with all applicable patient protection laws. We urge you to rescind this and other policies that restrict patients' access to care and put patients' health outcomes at risk.



Richard J. Pollack

President and Chief Executive Officer





Related Articles:

Recent Articles

Meharry Medical College and University of Memphis Launch PECIR Program, Driving Research Collaborations

Read More

UPDATE: UnitedHealthcare Policy on Emergency Coverage

Read More

ACEP Condemns UnitedHealthcare's New Policy to Retroactively Deny Emergency Care

The American College of Emergency Physicians (ACEP) strongly condemns the dangerous decision by UnitedHealthcare to retroactively deny emergency care claims.

Read More

Gerald E. Harmon, M.D., Inaugurated as 176th president of the AMA

Gerald E. Harmon, M.D., a family medicine physician from Pawleys Island, S.C., will be sworn in today as the 176th president of the American Medical Association (AMA), the nation's premier physician organization.

Read More

American Telemedicine Association: Policy Halftime Report As State Legislators Head Into Summer Recess

As most state legislators head into summer recess, the American Telemedicine Association (ATA) reflects on a very active first half of the year, which saw all 50 state legislatures introducing new or updated telehealth bills.

Read More

NIH-funded study tests "one-stop" mobile clinics to deliver HIV, substance use care

One of five mobile health clinics deployed for the NIH-funded INTEGRA study. Artwork for the clinic was designed by artist Shepard Fairey.

Read More

COVID-19 Pandemic Brought Changes in Cigarette Smoking: Study

Smokers who believed they were at increased risk of getting COVID-19 during the pandemic, or having a more severe case, were more likely to quit while those who perceived more stress increased smoking, according to new research published in the Journal of General Internal Medicine.

Read More

Secret Shopper Study Sheds Light on Barriers to Opioid Treatment for Women

After a 2020 Vanderbilt University Medical Center study showed women have a difficult time accessing treatment for opioid use disorder (OUD), investigators analyzed comments received from the study's participants to further shed light on barriers to care, which included everything from long on-hold times to difficult interactions with clinic receptionists during phone calls seeking appointments.

Read More

Predictive Model Identifies Patients for Genetic Testing

Patients who, perhaps unbeknownst to their health care providers, are in need of genetic testing for rare undiagnosed diseases can be identified en masse based on routine information in electronic health records (EHRs), a research team reported today in the journal Nature Medicine.

Read More

AMA Announces New Effort Aimed at Standardizing Blood Pressure Measurement Training at Medical and Health Profession Schools Across the U.S.

New e-learning modules provide consistent, evidence-based BP measurement techniques for students at health care schools nationwide--addressing gaps in current training to improve national blood pressure control rates

Read More

Email Print



Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: