Biggest health insurer plans to deny ER bills if it doubts you had an emergency

Multistory glass-and-brick building with UnitedHealthcare logo on exterior.

Enlarge / UnitedHealth Group Inc. headquarters stands in Minnetonka, Minnesota, U.S., on Wednesday, March 9, 2016. (credit: Getty | Bloomberg)

Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.

In the future, if one of UHC’s 70 million members submits a claim for an emergency department visit, UHC will carefully review what health problems led to the visit, the “intensity of diagnostic services performed” at the emergency department (ED), and some context for the visit, like the member’s underlying health conditions and outside circumstances. If UHC decides the medical situation didn’t constitute an emergency, it will provide “no coverage or limited coverage,” depending on the member’s specific insurance plan.

Emergency medical doctors and hospitals were quick to rebuke the plan. They say it sets a dangerous precedent of requiring patients to assess their own medical problems before seeking emergency care, which could end up delaying or preventing critical and even life-saving treatment.

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