1 in 10 claims could be denied under new ER policy, UnitedHealthcare says

About 1 in 10 emergency room claims could be denied under a new UnitedHealthcare policy drawing backlash from hospitals and physicians, a spokesperson from the insurance company told the Post Crescent.

Across most states, UnitedHealthcare may start retroactively denying commercial coverage for ER visits that are determined to be nonemergent. The change is effective July 1.

Tracey Lempner, a spokesperson for UnitedHealthcare, told the Star Tribune the change comes as "unnecessary use of the emergency room costs nearly $32 billion annually, driving up health care costs for everyone. 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."

Hospitals and physicians have condemned the policy and called for its reversal, arguing it would harm patient care and violate the prudent layperson standard. The standard requires health insurers to cover emergency health services based on presenting symptoms, not final diagnosis.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months