UnitedHealthcare faces intense backlash for new ER visit policy

UnitedHealthcare (UNH) announced this week it would start rejecting claims for non-emergency visits to the emergency room starting July 1.

The move has been met with stark criticism from patient advocacy groups and health experts who worry the move will discourage people from seeking care when they need it. But the health industry has long worried about the excessive cost of over-reliance on the ER.

"The emergency door is the most expensive entrance into the hospital, any hospital," health expert Michellene Davis told Yahoo Finance.

UnitedHealthcare said it isn't a blanket rejection policy and takes into account the reason a person comes into the ER, the intensity of diagnostic services needed, and whether the issue is a threat to the patient's health because underlying risk factors.

"Unnecessary use of the emergency room costs nearly $32 billion annually, driving up health care costs for everyone," according to a UHN statement to Yahoo Finance.

The goal is to urge individuals to seek care in less costly settings, such as urgent care or primary care offices and tele-health. But most of these options are only available during the day or evening. Later at night, emergency rooms remain the only option.

It's why advocates have pushed back on the rule, saying it places too much of a burden on patients.

Dr. Megan Ranney, an emergency room doctor at Brown Emergency Medicine, took to social media to explain.

"This policy is horrible. Patients shouldn’t be forced to decide if they’re having an 'emergency,'" Ranney said.

She and others have said that some seemingly inane issues could have urgent underlying impacts.

"I’ve taken care of people with…'pink eye' who had vision-threatening infections," she siad.

The American Hospital Association also pushed back Tuesday, calling for the company to reverse its decision.

"UHC may believe inappropriate use of the emergency room is a widespread problem; however, there is limited evidence to support this view," AHA said in its letter to UHC.

One key demographic that is unaffected by the new policy is individuals covered through Medicare or Medicaid, as the policy only applies to commercial plans. This, according to Davis, a former hospital executive and current CEO of National Medical Fellowships, is a small but bright spot.

UHC is not the first to come up with such a policy. Anthem (ANTM) rolled out a similar policy in 2018, which faced similar backlash.

Both companies have pages on their company websites to help guide members on ER versus urgent care use.

While UnitedHealth did not express which reasons for a visit it could deny, a post from 2019 offers some insight.

"According to UnitedHealth Group research, two-thirds of hospital ED visits annually by privately insured individuals in the United States – 18 million out of 27 million – are avoidable. Ten common primary care treatable conditions frequently treated at hospital EDs are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection," according to the post.

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