UnitedHealthcare’s New, Harmful ER Policy

By Consumers for Quality Care, on March 26, 2018

The nation’s largest health insurer has announced a new ER policy that could have negative consequences for consumers.

UnitedHealthcare will analyze claims submitted by hospitals to determine if the ER had upcoded. According to Naples Daily News:

UnitedHealthcare will be using an “emergency department claim analyzer tool” that will determine the appropriate coding “based on data such as a patient’s presenting problem, diagnostic services performed during the visit and associated patient co-morbidities,” according to a December bulletin sent to hospitals. Hospitals will see claims reduced or denied when coding was inappropriate, the insurer bulletin said.

Opponents worry that hospitals could pass the cost of UnitedHealthcare’s new policy onto consumers.

But hospitals could “balance bill” patients for what the insurer does not pay, depending on the balance billing laws in their states, said Laura Wooster, executive director of public affairs for the American College of Emergency Physicians in Washington, D.C.

The new policy comes after months of pushback from hospitals, patients, and advocates against Anthem’s harmful ER policy.