UnitedHealthcare delays policy to stop paying for some ER care

·2 min read

UnitedHealthcare is putting on hold a new policy that would have stopped payments for non-emergency care in ERs beginning next month.

Physicians and hospitals strenuously objected to the plan, with emergency physicians saying the change threatened progress in the fight against COVID-19.

"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," UnitedHealthcare said Thursday in a statement.

"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," the insurer said.

Minnetonka-based UnitedHealthcare is the nation's largest insurer.

Under the delayed policy, the company would review ER claims based on a patient's presenting problem, the intensity of diagnostic services provided and factors such as complicating health conditions. Claims deemed to not meet the criteria of an emergency medical condition, or "non-emergent," either wouldn't be covered, the insurer said, or would be subject to limited coverage.

The goal was to promote appropriate use of ERs, the insurer said, while reducing health care costs.

Medical societies objected to the change, saying it could have a chilling effect on patients who might refrain from seeking care when needed. The American College of Emergency Physicians said this week that it "strongly condemns" the policy, which is similar to others health insurers have tried over the years.

"We are not, unfortunately, surprised to see an insurance company once again try to cut its costs at the expense of necessary patient care," Dr. Mark Rosenberg, president of the emergency physicians group, said in a statement earlier this week. "UnitedHealthcare is expecting patients to self-diagnose a potential medical emergency before seeing a physician, and then punishing them financially if they are incorrect."

This is a developing story. Check back for updates.