A delayed UnitedHealthcare policy that aims to deny "nonemergency" emergency room coverage violates patient protections, the American College of Emergency Physicians claims.
According to Bloomberg Law, the college is considering suing the insurer on similar grounds as its pending lawsuit against Blue Cross and Blue Shield of Georgia, which points to policies that retroactively deem trips to the emergency room as "nonemergent," thereby denying coverage.
In challenging UnitedHealthcare, the college is alleging the emergency room coverage policy is in violation of the prudent layperson standard. The federal protection requires insurers to cover an emergency room visit based on reported symptoms, not a final diagnosis.
Policies like UnitedHealthcare's that initially deny unnecessary visits until they are disputed have a "chilling effect" on decisions to seek care, according to a letter penned by the college.
Bloomberg Law reports that UnitedHealthcare's decision to maintain the policy could set the standard for the industry.
"It’ll become the industry standard," Wendell Potter, former Cigna executive and president of Center for Health and Democracy, told Bloomberg Law. "Even if you’re not a member of UnitedHealthcare, you should be concerned about this because your insurance company will be likely to follow this at some point."