UnitedHealthcare May Deny Emergency Visit Coverage
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“Unnecessary use of the emergency room costs nearly $ 32 billion annually, which drives up healthcare costs for everyone,” the company said in a statement Monday. “We are taking steps to make care more affordable and we are encouraging people who do not have a medical emergency to seek treatment in a more appropriate setting, such as an emergency center. If any of our members are treated in an emergency room for a problem such as conjunctivitis, we will reimburse the emergency facility according to the member’s benefit plan. “
During the pandemic and months of lockdown, non-Covid supplies, ranging from knee surgeries to mammograms to visits to the emergency room, declined. While some experts feared that the lack of care would worsen patients’ condition, others argued that the decline might provide evidence that some care, such as screening, was unnecessary.
United’s initial decision was viewed by some critics as a message directed at hospitals.
“They see this as a way to get the upper hand in their constant battle with providers,” said Jonathan Kolstad, health economist at the University of California, Berkeley.
It was the latest example of the insurer’s clash with doctors and hospitals, said Michael R. Turpin, a former United manager who is now executive vice president at USI, an insurance broker that helps companies find insurance coverage. More recently, United’s sparring with anesthetists led to lawsuits from a large medical practice backed by private equity investors, and hospitals complain that United has put in place other policies that make it difficult for patients to secure their care.
Some consumers are already battling insurers and some vendors over billing for Covid vaccines, leading the federal government to remind attendees that it is illegal to bill patients for these costs.
There is also growing evidence that some of the people who did not go to the emergency room during the pandemic would have been better off seeking help. Experts pointed to the rise in death rates from heart disease, diabetes and other illnesses, which could suggest people are putting off necessary care. A recent study in Health Affairs conducted 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 of the hospital, particularly in low-income neighborhoods.
Pollack noted that such a policy would be problematic even after a pandemic: “There is no justification for these restrictions now or after the public health emergency,” he said.