The American College of Emergency Physicians (ACEP) has strongly condemned a decision by UnitedHealthcare to retroactively deny emergency care claims.
The health insurance giant was slated to instate a new policy on July 1, but after public backlash, has decided to defer implementation until the coronavirus pandemic is over.
ACEP said they believe that the new policy is in direct violation of the federal Prudent Layperson Standard, which requires insurance companies to provide coverage of emergency care based on the presenting symptoms that brought the patient to the emergency department, not the final diagnosis.
According to the Centers for Disease Control and Prevention (CDC), only 3% of emergency visits are “non-urgent.” With 90 percent of symptoms overlapping between non-urgent and emergent conditions, in many instances, even physicians cannot know if a patient’s symptoms require emergency treatment without conducting a comprehensive medical examination. They say it’s the very reason the Prudent Layperson Standard exists, to protect patients.
“While we’re dismayed by United’s decision, we are not, unfortunately, surprised to see an insurance company once again try to cut its costs at the expense of necessary patient care,” said Mark Rosenberg, DO, MBA, FACEP, president of ACEP. “UnitedHealthcare is expecting patients to self-diagnose a potential medical emergency before seeing a physician, and then punishing them financially if they are incorrect.”
Throughout the pandemic, ACEP and other medical societies have been encouraging the public to not delay medical care, especially in case of an emergency. ACEP says decisions like this from insurance companies could severely undermine our collective efforts to get the virus under control.
Anthem, which operates Blue Cross announced a similar policy in the past, leading to a lawsuit from ER doctors and that litigation is still continuing.
“We have decided to delay this program. 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. 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.”
“Lee Health stands with the American Hospital Association in encouraging UnitedHealthcare to reconsider their new emergency department coverage policy. This policy asks patients to make medical decisions they are not trained to, and could lead to catastrophic health outcomes if people become hesitant to seek emergency care when they truly need it. This is a dangerous policy that is not in the best interest of patients or their safety.”
American Hospital Association President and CEO Rick Pollack
“Today’s announcement from UnitedHealthcare to delay its new policy on emergency coverage offers a temporary reprieve for patients, and we urge its full and permanent reversal. If enacted, this policy would have a chilling effect on patients seeking emergency services, with potentially dire consequences for their health. 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.”
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