Critics Call UnitedHealthcare's New ER Policy Dangerous

Robert59

Senior Member
Patients could be on the hook for visits later deemed to be nonemergencies

UnitedHealthcare says a new policy will reduce health care costs by reducing unnecessary emergency-room visits—but doctors warn there are some very obvious downsides to discouraging people from going to the ER. The policy the insurer is bringing in on July 1 will retroactively assess claims for emergency room visits, and those deemed to be nonemergencies will be subject to no coverage or limited coverage, depending on a patient's plan, USA Today reports.

https://www.newser.com/story/307216/critics-call-unitedhealthcares-new-er-policy-dangerous.html
 

If an ER visit is denied and you appeal the decision, always use the words "any prudent layman" in the wording of your appeal. I.E. "I experienced a bad pain in my side at 10 p.m. and I did what any prudent layman would do; I went to the ER."

From my years of working for insurance companies, I can tell you that that phrase gets your appeal out if the "automatically denied" pile and into the "hmmmmm, this guy is going to fight" pile.

Even the best companies aren't in the business for your advantage, even if their advertising paints them as the White Knights coming to your rescue. They're in it to make money for their shareholders and one of those ways is to not pay for anything they can get by with.
 

DaveA

Senior Member
Just curious but in your years of working for these companies, are there many cases of people using the ER unnecessarily? Only inquire because one of my grand-daughters has worked as a nurse in the ER and she has mentioned that certain nights of the week they are overrun by people (many under the influence) who truly have no need to be there.
 

OneEyedDiva

Well-known Member
Location
New Jersey
If an ER visit is denied and you appeal the decision, always use the words "any prudent layman" in the wording of your appeal. I.E. "I experienced a bad pain in my side at 10 p.m. and I did what any prudent layman would do; I went to the ER."

From my years of working for insurance companies, I can tell you that that phrase gets your appeal out if the "automatically denied" pile and into the "hmmmmm, this guy is going to fight" pile.

Even the best companies aren't in the business for your advantage, even if their advertising paints them as the White Knights coming to your rescue. They're in it to make money for their shareholders and one of those ways is to not pay for anything they can get by with.
I don't have United Healthcare (UH) but you've provided great advice for anyone who may need to appeal.

Re the OP: I would hope that they will recognize what true emergencies are and not penalize people who presented with reasonable ailments. A little off topic: My sister has UH and one thing I found out about them, it can be hard to transfer to a rehab facility. The social worker (or nurse...forgot which) came into my sister's room after her knee replacement and told her they were having difficulty finding a facility because of her insurance. Later at the Patient Council Advocacy group I belong to, sponsored by my doctor's office, the nurse practitioner and secretary said they've had that same problem with UH.
 
That's another trick the insurance companies like to play....."we can't find a facility for you." Yes, they can....they just don't want to because they may have to pay a little more. But you are ENTITLED to go directly to a rehab facility after three days in the hospital or you get to stay in the hospital until they find you a facility.

They definitely don't want to pay for you to stay in the hospital. What they'd like is for you to roll over and say, "OK, I'll go home and give it a try."

In a situation like that, you keep saying, "I can't take care of myself at home. No, I can't take care of myself at home. No, I don't feel like I can safely take care of myself at home." Keep saying that until the situation is remedied. They can't kick you out of the hospital if you feel like you can't take care of yourself at home.

When my mother had her knee replaced, they tried the "we can't find you a facility" routine. My sister and I kept telling them that my mother couldn't take care of herself. "Well, can't YOU take care of her?" "No, I can't provide the care she needs." Rinse and repeat. In a rehab facility, she would have PT twice a day. At home, it was once a day at best. In a rehab facility, there would be medical personnel immediately available. At home, there was just me and I'm not an RN. Any medical problems would consist of waiting for a visiting nurse to come or an ambulance back to the hospital. Nope, nope, nope.

Spending years on the "denying end" of the equation made me very, very aware of what our rights were. It was an education, one that I've used to our advantage many times.
 

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