PAMED Statement: UnitedHealthcare to Stop Payments for Non-Emergency Care in ERs

Last Updated: Jun 10, 2021

If you think health insurers aren’t making life and death decisions, think again. A policy change recently announced by United Healthcare will most certainly deter acutely ill patients from doing what is in their best interest…going to the emergency room. United Healthcare wants to stop paying for what it determines is non-emergency care that’s provided in emergency rooms, and that just isn’t right.

The insurer recently announced that, starting in July, most states will review ER claims to evaluate whether the visit should be paid for considering the problem(s) that brought the patient to the ER, the intensity of diagnostic services provided, and factors such as complicating health conditions. Claims that do not meet their criteria of an emergency medical condition (i.e. non-emergent) either won’t be covered or will be subject to limited coverage.  In other words, premium dollars paid by employers, or by patients themselves, really don’t matter.

After pressure from medical societies and provider partners, United Healthcare has delayed, not discontinued, its plan. It’s now to go into effect at the end of the public health emergency.

This is yet another example of health insurers collecting premium dollars from hard working Americans only to turn around and kick them when they’re down. More alarming is that United Healthcare doesn’t want to pay for patient ER visits, but happily encourages patients to instead visit urgent care centers like MedExpress, which they own!

The Pennsylvania Medical Society objects to this policy. Our patients deserve better. We strongly believe that doctors and their patients – not insurance companies – should be making all treatment decisions, including where the patient receives care, especially when they feel emergency care may be needed. Policies such as this only hinder patient access to timely care.

A patient experiencing chest pain shouldn’t give a moment’s thought to calling 911 or visiting an emergency room even if it could be nothing more than angina. This policy will most certainly deter patients from seeking appropriate emergency care if they think their insurance company will deny payment. It could be dangerous, even life threatening, to leave clinical medical decisions up to patients, especially at a critical moment when time could be of the essence.

“We must preserve patient access to critical emergency care,” said PAMED President Michael A. DellaVecchia, MD, PhD,
FAAO, FACS, FICS, FASLMS, FCPP. “Human life should NEVER be part of a company’s bottom line.”


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Media Contact
Claire Shearer
MediaRelations@pamedsoc.org 

About the Pennsylvania Medical Society
PAMED is a physician-led, member-driven organization representing all physicians and medical students throughout the state. We advocate for physicians and their patients, educate physicians through continuing medical education, and provide expert resources and guidance to help physicians and their organizations navigate challenges in today’s ever-evolving health care system. For more information, visit www.pamedsoc.org.

2 comments

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  1. Samuel Wilson | Jun 10, 2021
    Just one more step in a dysfunctional system lacking ethical backbone. 
  2. Samuel Wilson | Jun 10, 2021

    Ultimately the Physicisn is being marginalized in the care process. Decisions in care  are being patentsized  , and restricted. This leads to limited differential diagnosis analysis . This alternative process interferes with the  decision thinking .

        We must remove fees’ for service as the reimbursement formula  and replace that policy practice with payment for Care- not just service. Care= Delivering the most efficient effective ,accurate, necessary and meaningful intervention in the moment based on the present circumstances. That delivery must be directed toward the specific patient’s pathology, response , potential  adaptivness and most important , it must be timely delivered. 

    There is a disconnect in the system; patient’s are left to uncertainty,  indecision, changing rules , challenges to access,  while care delivery is being manipulated by the  Insurance Provider using cost containment as the motivation. This cost containment is where care delivery is early impacted. This is also where restrictions are being more closely implemented to limit physician recommendations or advice. 

    This partnership  is not genuine , or sincere as it relates to the delivery off care. The insurance company has one objective , reduce payment for service in any way possible.   This often produces  a reduced care service,  created and manipulated using increased hurdles as strategy. 


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