UnitedHealthcare wants to retroactively bill for ‘nonemergency’ ER visits.
The U.S.’s largest insurance company, UnitedHealthcare, has proposed it would implement a policy that would retroactively bill patients for ER services if the insurer decides the situation was not actually an emergency. This means, despite Covid-19 and chronic conditions that require frequent hospitalization, whether the patient should visit the emergency room or not lies with UnitedHealthcare, and this could mean that patients will not get the services they need for fear of being hit with substantial bills.
UnitedHealthcare’s new ER services policy will affect millions U.S. residents across 35 states, and it will further hinder the ability to receive care in already underserved communities. According to a Journal of Public Health and Emergency study, “more than 100 million Americans annually use emergency department services.” The authors concluded that “women use the emergency department 25% more often than males. Black Americans under the age of 65 use the emergency department 10-19% more often than White Americans.”
If UnitedHealthcare successfully implements this policy, other insurance companies are likely to follow suit and retroactively bill for ER services. Wendell Potter, a former Cigna executive and now president of Center for Health and Democracy, said, “It’ll become the industry standard. Even if you’re not a member of UnitedHealthcare, you should be concerned about this because your insurance company will be likely to follow this at some point.”
“We shouldn’t reduce emergency department visits because we expect to save money,” Laura Burke, a physician at Beth Israel Deaconess Medical Center in Boston added. “Because there is no evidence that’ll actually happen.”
“The problem is not that patients overuse or misuse the emergency room,” explained Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. So, the decision to implement the change is unwarranted. She added, “It’s not fair to patients. It puts the patients in the middle.”
The real problem is increases to pricing at the hospitals themselves and some believe that UnitedHealthcare’s policy serves as a warning that these facilities will see a reduction in the number of patients seeking care if the trend continues.
UnitedHealthcare and other insurers have been able to more than double their revenue during the coronavirus pandemic compared to previous years. They aren’t losing money as the virus continues to spread. The company is taking advantage of the current state of affairs and causing underserved populations to live in fear of receiving surprise medical bills.
If left in a patient’s hands, especially one who is not an expert or well-versed in medical care, a decision to stay home when something is life-threatening is bound to happen. The medical community is supposed to take care of people and physicians are supposed to determine whether a condition is serious – not an individual worried about the cost.
The Healthcare Equality Network has sent a letter to President Biden, Congresswoman Beatty, and the Congressional Black Caucus urging them disallow this initiative and any others that could follow. If this policy is not stopped before it’s implemented, it could be detrimental to many people during an especially trying time.