UnitedHealthcare delays ER coverage policy amid provider backlash

UnitedHealthcare
UnitedHealthcare has delayed its new emergency department coverage policy amid pushback from providers. (jetcityimage/Getty)

Amid significant backlash from providers, UnitedHealthcare is delaying its new emergency department coverage policy, which would allow the insurer to retroactively deny ED claims it determines are nonemergent.

The policy was set to take effect July 1 in fully insured commercial plans. A spokesperson for UnitedHealthcare said in a statement to Fierce Healthcare that the policy will be pushed back until at least the end of the national public health emergency period for COVID-19.

When that window will close is unclear, though most experts expect the public health emergency to last at least through the end of 2021.

"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," the spokesperson said. "We will use this time to continue to educate consumers, customers and providers on the new policy and help ensure that people visit an appropriate site of service for non-emergency care needs."

RELATED: AHA urges UnitedHealthcare to roll back new emergency department coverage policy

The news was first reported by The New York Times.

Provider groups including the American Hospital Association (AHA) and the American College of Emergency Physicians (ACEP) slammed the country's largest commercial insurer, especially for the timing of the announcement, which comes as the U.S. is still emerging from a pandemic that significantly decreased patient volumes.

In a statement, ACEP said it and other provider organizations have urged patients who may be experiencing high-risk symptoms to seek out emergency care amid the pandemic to avoid a potentially dangerous situation such as a heart attack out of fear of COVID-19.

“Over the past year, we’ve seen the devastating impact of when patients avoid treatment—including worsening health conditions and even death. This new policy will leave millions fearful of seeking medical care, just as we’re getting hold of the COVID-19 pandemic and trying to get as many people vaccinated as possible,” said Mark Rosenberg, president of ACEP.

UnitedHealthcare said the goal of the policy was to avoid high, unnecessary emergency room costs and instead encourage patients to seek care at other sites, such as urgent care. If a claim was deemed nonemergent, the provider would be able to sign an attestation to reverse the decision.

If the attestation was submitted within the allotted time frame, UnitedHealthcare said it would cover the visit under the member's emergency care benefit.

In a statement Thursday, AHA reiterated its call for UnitedHealth to fully nix the policy.

"If enacted, this policy would have a chilling effect on patients seeking emergency services, with potentially dire consequences for their health," the group said. "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," AHA said.

Anthem took heat for a similar policy it unveiled in 2017, with ACEP filing suit against the insurer over it.