Insurance giant's new ER policy called 'dangerous' by critics. It says as many as 1 in 10 claims cou

[Northeast Agent]

UnitedHealthcare to assess ER claims, sticking patients with bills

UnitedHealthcare’s policy affects commercially insured patients with employer-sponsored plans and does not apply to patients with Medicare Advantage or contracted Medicaid coverage with UnitedHealthcare, Lempner said.

The insurer’s parent company, UnitedHealth Group, earned $6.7 billion in the first quarter of the year, according to the hospital association.

“Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency,” Pollack said in his letter. “Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care.

 

[kgmom219]

They yanked it today.

Outcry Forces UnitedHealthcare to Delay Plan to Deny Coverage for Some E.R. Visits

 

[Northeast Agent]

Kgmom219 said:

They yanked it today.

That was fast...

 

[somarco]

I have mixed feelings about this.

When you realize there is a certain segment of the population that uses the ER as a substitute for a PCP I think carriers are right to enforce some rules.

They don't pay for care that is not medically necessary and never have. This just plants the seed that, "If you go to the ER you better have a critical medical need".

Walk-in urgent care facilities are a better and more economical choice.

 

[Northeast Agent]

somarco said:

When you realize there is a certain segment of the population that uses the ER as a substitute for a PCP I think carriers are right to enforce some rules.

I have a color-coded chart somewhere, from a company I'm appointed with to sell indemnity plans. It tells you what conditions you should see your PC for, when to use the ER, urgent care, etc.

Friends of mine from Britain used to socialized medicine have gone to the ER here for things I think are ridiculous (breastfeeding issues ,etc).

 

[kgmom219]

This thing was stupid from start to finish.

1. Most states have "layman" rules for ER claims, so it was only for self funded plans anyway
2. How stupid do you have to be to send it out to every agent and more importantly, every ER DOC in the country?

People would stop going to the ER if they had coverage. And until the Medicaid non expansion states wake up, its going to continue to be a problem