Health Leaders to Nation’s Largest Private Insurer: Abandon Dangerous Policy to Deny Coverage for Emergency Care

WASHINGTON, D.C.—The American College of Emergency Physicians (ACEP) and 32 organizations comprising patient advocates, hospitals, and physicians across medical specialties call on UnitedHealthcare (UHC) to permanently abandon its planned policy to retroactively deny patients’ emergency care claims. These denials violate federal law and put lives at risk, the leaders said in a letter sent to UHC this week.

The joint letter underscores that the proposed policy violates the “prudent layperson standard” and is based on the faulty assertion that patients should know what symptoms constitute a medical emergency. The groups state:

“[M]ost clinicians cannot make a diagnosis with confidence without the support of a wide range of tools and tests. A 2013 JAMA study found that patients who receive a diagnosis of a low-acuity condition often present with initial complaints similar to patients with more serious conditions.”

The letter argues that the policy is especially dangerous for vulnerable patients—many of whom rely on the emergency department as their primary or only source of care.

“Emergency departments (EDs) around the country often serve as the only safety net for a fragmented mental health infrastructure. For those in crisis for whom the ED is a lifeline for care, an added threat of a retroactive denial of coverage under this policy can be devastating.”

UHC announced the new policy on June 4 and quickly decided to temporarily delay its implementation only six days later after swift backlash. ACEP is leading the pushback, building on its previous advocacy efforts—including an ongoing lawsuit—against other insurers who have tried to impose similar dangerous policies. The main concern is the widespread effects this could have as millions of patients delay or avoid seeking emergency care because they worry their insurer will leave them with the bill.

“It will have a chilling effect on patients’ decisions to seek care, whether for themselves or for a loved one…Such hesitation could be life-threatening or result in even greater costs to the healthcare system down the road.”

In order to protect the nation’s 150 million emergency patients, ACEP is resolute that a delay is insufficient—UHC needs to get rid of the policy altogether.

“Only full and permanent rescission of the policy will ensure the safety of our patients and your enrollees, and we urge you to take such action immediately,” the letter concludes.

Click here to view the full letter.  

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million Americans they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org

Contact: Steve Arnoff | sarnoff@acep.org | Twitter @EmergencyDocs

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