UnitedHealthcare will not cover remote physiologic monitoring when it is “unproven and not medically necessary,” including for Type 2 diabetes and most cases of hypertension. However, it will still cover monitoring for heart failure and hypertensive disorders of pregnancy, according to a policy that is set to go into effect next year.
Remote monitoring is the collection of a patient’s physiological data for healthcare professionals to devise and execute a treatment plan.
The new policy affects Medicare Advantage, commercial and individual exchange, and Medicaid members.
By reviewing research, UnitedHealthcare said it determined pregnant patients with gestational hypertension had reduced antenatal visits if they underwent home blood pressure monitoring. For heart failure, half of the assessed tools used for noninvasive remote monitoring boosted outcomes.
According to a CMS rule, the agency will rely on hospital data to set rates for some of these services next year. The Remote Monitoring Leadership Council previously sent a letter to CMS Administrator Mehmet Oz, MD, outlining potential cost savings and patient outcomes associated with monitoring.
