The hospital advocacy group said patients will likely be caught unawares when coverage for emergency care is denied.
January 3, 2022 / Jeff Lagasse, Associate Editor
UnitedHealthcare recently announced it would move forward with new coverage criteria for emergency-level care, which went into effect January 1, and this has drawn the ire of the American Hospital Association, which is urging UHC to rescind the policy.
Beginning January 1, UHC began reviewing claims for emergency services to evaluate whether a patient should access care in the emergency department. If UHC believes that emergency-level care isn’t warranted, it may deny the claim.
“The result is that either patients must then pay for their care without any assistance from their health plan, or the emergency department and clinicians who care for the patient forego billing and absorb the loss of reimbursement,” the AHA wrote in a letter to UHC.
The hospital advocacy group said that since UHC announced the change after many people had already selected their health plans for the year, patients will likely be caught unaware when coverage for emergency care is denied.
The AHA expressed a number of concerns – chief among them that the new coverage criteria comes six months after UHC said publicly that it would not implement a new emergency service coverage policy until at least the end of the public health emergency. With COVID-19 case counts on the rise once more, the AHA maintains that the PHE is far from over.