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UnitedHealthcare Delays 'Dangerous' Emergency Room Coverage Policy

UnitedHealthcare insurance company, the largest of its kind within the U.S., announced on Thursday it will delay rolling out a new and controversial emergency department policy, The New York Times reports.

The change, which would be effective July 1, would begin to retroactively assess any and all emergency department or ED insurance claims to determine whether or not the visit was truly “emergent” or “non-emergent.”

Claims will be evaluated based on patients’ conditions, the variety of tests and diagnostics run while visiting, other complications and more. The company says if a claim is given a “non-emergent” status, patients can contest the update by accessing paperwork online.

The American College of Emergency Physicians (ACEP) issued a recent press release saying that the organization “strongly condemns that dangerous decision by UnitedHealthcare to retroactively deny emergency care claims.”

ACEP claims that the policy will violate the Prudent Layperson Standard for insurance companies — a federal law that works with the Emergency Medical Treatment and Labor Act (EMTALA) which requires insurance companies to provide some form of emergency care regardless of a policy holder’s ability to pay or insurance level.

According to Healthcare Finance, the policy could also significantly impact healthcare providers financially in the wake of upheaval following COVID-19. However, the UnitedHealthcare Group has stated that the policy was generated after recognizing that emergency department misuse by patients costs insurance companies and healthcare networks $32 billion a year.

Anthem insurance company instituted a similar policy in 2017 which received a similar backlash. However, by 2018, the company elected to walk the newer policy back since so many healthcare providers filed complaints in order to protect their patients’ wellbeing.

ACEP’s press release reveals that their members believe this is another effort to save healthcare insurance companies, and included a statement by a provider named Dr. Rosenberg, “Over the past year, we’ve seen the devasting 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.”

The Centers for Disease Control and Prevention claim that between 3-10% of all emergency visits are classified as “non-urgent.” Besides this, female patients and Black or African American patients were the two largest groups needing emergent healthcare.

These two groups are also the two most likely to experience discrimination, denial of appropriate treatment and medication, and to experience medical gaslighting.

For those with disabilities, particularly those that encompass chronic pain conditions and other serious co-morbid conditions, this policy being instituted by such a large health insurance company could prove dangerous to certain critical aspects of their healthcare.

As of 2021, one-fifth of the estimated global population and 26% of the United States’ population is disabled.

Of that number, 10% of all disabled Americans have no health insurance whatsoever.

Getty image via ymgerman