UnitedHealthcare may deny coverage for emergency visits

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“Unnecessary ER use costs nearly $32 billion a year, 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 medical emergency to seek care in a more appropriate setting, such as an urgent care centre. If one of our members receives care in an emergency room for a condition, such as pink eye, we will reimburse the emergency according to the member’s benefit plan.

During the pandemic and for months in lockdown, non-Covid care, ranging from knee surgeries to mammograms to emergency room visits, has plummeted. While some experts worried the lack of care could make patients worse, others argued the drop could provide evidence that some care, like screenings, was unnecessary.

United’s initial decision was seen by some critics as a message to hospitals.

“They see it as a way to gain the upper hand in their perpetual battle with providers,” said Jonathan Kolstad, a health economist at the University of California, Berkeley.

It was the latest example of the insurer clashing with doctors and hospitals, said Michael R. Turpin, a former United executive who is now executive vice president of USI, an insurance brokerage firm that helps businesses find coverage. More recently, United’s fights with anesthesiologists have led to legal action from a major doctor-owned firm backed by private equity investors, and hospitals are complaining that United has adopted other policies that make it difficult for patients to cover their care.

A few consumers are already battling insurers and some providers over billing for Covid vaccines, prompting the federal government to remind participants that it is illegal to charge these costs to patients.

There is also growing evidence that some of the people who did not go to the emergency room during the pandemic would have done better to seek treatment. Experts have pointed to rising death rates from heart disease, diabetes and other illnesses that may indicate people are putting off needed care. A recent study in Health Affairs by researchers at MIT Sloan School of Management, in collaboration with Boston Emergency Medical Services, found evidence of an increase in heart attacks occurring outside the hospital, particularly in low-income neighborhoods.

Mr Pollack noted that even after the pandemic such a policy would be problematic: “There is no justification for these restrictions now or after the public health emergency,” he said.

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