UNITEDHEALTHCARE SUSPENDS POLICY THAT WOULD LIMIT PAYMENT FOR ER VISITS IN FACE OF PROVIDER OPPOSITION

Faced with fierce opposition from the provider community, UnitedHealthcare has suspended its controversial policy that would have allowed it to deny all or part of a patient’s treatment in a hospital’s emergency department if United determined after-the-fact that the patient had been treated for a non-emergent condition.  
 
The American Hospital Association, the American Medical Association, and the American College of Emergency Physicians had all strongly opposed the policy, expressing concern that patients would forego treatment in an emergency department even when faced with a real health emergency.  For example, Susan R. Bailey, MD, the president of the AMA stated:  “Patients should not be expected to self-diagnose to determine whether, for example, chest pain is a heart attack or indigestion.”  In a letter to United, AHA chief executive Rick Pollock likewise stated:    
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. This is dangerous for patients’ health at any time, but it is particularly unsafe in the midst of a public health emergency.  
In suspending the policy, United acknowledged the concerns expressed by providers, stating: “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.”   
 
Although expressing relief that United had suspended the policy, providers urged United to permanently withdraw it. 
 
Whatley Kallas, LLP’s earlier post discussing the AHA letter is linked here.