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New UnitedHealthcare policy allows insurer to retroactively deny ER claims


Hospitals and physicians are condemning a new UnitedHealthcare policy under which the insurer may retroactively deny some emergency department claims, Fierce Healthcare reported. Effective July 1 across most states, UnitedHealthcare, the largest U.S. health insurer, may not fully cover an emergency room visit for its commercial members if it determines that their condition didn’t warrant a trip to the ER. It’s similar to a policy Anthem has in place for emergency room care. In a June 8 letter to UnitedHealthcare’s CEO Brian Thompson, American Hospital Association CEO Rick Pollack wrote that the new policy would jeopardize patient care and should be immediately reversed. “Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency. Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care,” the letter said. The AHA, along with the American College of Emergency Physicians, argue that the policy violates the federal prudent layperson standard. The standard requires health insurers to cover emergency health services based on presenting symptoms as opposed to final diagnosis.

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