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Outcry forces UnitedHealthcare to delay plan to deny coverage for some ER visits

Hospitals and doctors had raised concerns that the now-postponed UnitedHealthcare policy signaled a return to a contentious tactic used by health insurers to clamp down on care they argued should be delivered in a less costly setting.
Hospitals and doctors had raised concerns that the now-postponed UnitedHealthcare policy signaled a return to a contentious tactic used by health insurers to clamp down on care they argued should be delivered in a less costly setting.Jim Mone/Associated Press

Just days after UnitedHealthcare announced that it would stop paying for emergency room hospital visits it deemed nonurgent, the company faced mounting opposition and said Thursday it would delay the policy shift until the pandemic had ended.

Under thepolicy, which was to go into effect next month, UnitedHealthcare had planned to scrutinize the medical records of its customers’ visits to emergency departments to determine if it should cover those hospital bills. But in the last week, several major hospital and doctor groups demanded that United abandon the policy.

“Plain and simple, this is a very misguided policy that could have a chilling effect for people going to the emergency room,” Rick Pollack, chief executive of the American Hospital Association, a trade group, said earlier this week.

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In a letter to UnitedHealthcare’s chief executive, Pollack sought a policy reversal and emphasized that the pandemic had demonstrated the risks of discouraging patients from seeking care.

“This is dangerous for patients’ health at any time, but is particularly unsafe in the midst of a public health emergency,” he said.

On Thursday, United acknowledged the concerns raised by many groups, in announcing its decision to delay the new policy: “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,” it said in a statement.

Hospitals and doctors had raised concerns that the new policy signaled a return to a contentious tactic used by health insurers to clamp down on care they argued should be delivered in a less costly setting.

Anthem, another large insurer that operates for-profit Blue Cross plans, announced a similar policy several years ago that led to a political backlash and a federal lawsuit from emergency room physicians claiming it violated federal protections for patients seeking emergency care. Anthem said it could not comment because of the continuing litigation.

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The policy shifts seemed puzzling when there had already been significant declines in emergency room visits throughout the pandemic into this year, which resulted in considerable savings and lower costs for insurers. Emergency room visits across the country fell by 27 percent in 2020, compared with the previous year, according to Gist Healthcare, a consultant, which predicts that people with less serious conditions will continue to stay away.

United’s decision seemed aimed at making sure people did not go back to their old habits, even as hospitals might try to persuade more people to return, said Chas Roades, a co-founder of Gist. He did not believe United was likely to generate significant savings from the program and could experience a backlash. “I can’t quite believe the juice is really worth the squeeze on this policy right now,” he said.

But many people also ignored worrisome symptoms and avoided seeking care, even if they were experiencing heart problems or other ailments. Although the coronavirus crisis has eased in the United States, people are still hesitant to seek medical help in crowded settings, and the numbers of patients being seen in emergency rooms have not rebounded.

Physician groups were also critical of the decision to deny coverage for emergency visits that United considered nonurgent.

“We object to UnitedHealthcare’s pending policy that asks patients to second guess their instincts that emergency care is needed,” Dr. Susan Bailey, president of the American Medical Association, said in a statement. “Patients should not be expected to self-diagnose to determine whether, for example, chest pain is a heart attack or indigestion.”

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United had insisted that its policy is not aimed at preventing customers from going to the emergency room to rule out a heart attack if they have chest pain or to address a medical crisis. The insurer said it would take into account the original reason for the visit, any laboratory work or imaging performed and whether there were existing medical conditions or other factors that could have warranted a visit. A hospital could still attest to the emergency needs, and patients can ultimately appeal.

“Unnecessary use of the emergency room costs nearly $32 billion annually, driving up health care costs for everyone,” the company said in a statement Monday. “We are taking steps to make care more affordable, encouraging people who do not have a health care emergency to seek treatment in a more appropriate setting, such as an urgent care center.”