News: UnitedHealthcare delays nonemergent ED visit policy amid provider pushback

CDI Strategies - Volume 15, Issue 24

Due to provider pushback, UnitedHealthcare announced that they will delay the policy which would allow them to deny ED claims determined nonemergent. The policy was set to take effect on July 1; now the payer says they will delay the policy at least until the end of the COVID-19 public health emergency.

“We will use this time to continue to educate consumers, customers, and providers on the new program and help ensure that people visit an appropriate site of service for non-emergency care needs,” the announcement says, responding to key concerns raised by the American Hospital Association (AHA) and others after the policy’s initial announcement.

According to the AHA, the policy would have put patients’ “health and wellbeing in jeopardy” by threatening them with financial penalties for choosing the “wrong” level of care.

“Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care,” the AHA wrote. “This is dangerous for patient’s 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 acuity.”

While the reversal offers a temporary solution, the payer hasn’t fully ditched the policy and it’s unclear when and if it will ultimately take effect. Provider organization such as the AHA are continuing to call for a complete and permanent reversal of the policy.

“There is no justification for these restrictions now or after the public health emergency,” the AHA says. “The AHA will continue to turn up the pressure on UnitedHealthcare and other commercial health insurers on actions that put patients’ health and wellbeing in jeopardy.” 

Editor’s note: To read about the initial policy announcement, click here. To read the AHA’s initial letter, click here. To read the announcement about the policy’s delay, click here. To read the AHA post following the delay, click here.

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