WASHINGTON, D.C.—The American College of Emergency Physicians (ACEP) strongly condemns the dangerous decision by UnitedHealthcare to retroactively deny emergency care claims. ACEP firmly believes that the new policy is in direct violation of the federal Prudent Layperson Standard, which requires insurance companies to provide coverage of emergency care based on the presenting symptoms that brought the patient to the emergency department, not the final diagnosis.
According to the Centers for Disease Control and Prevention (CDC), only 3 percent of emergency visits are “nonurgent.” With 90 percent of symptoms overlapping between nonurgent and emergent conditions, in many instances, even physicians cannot know if a patient’s symptoms require emergency treatment without conducting a comprehensive medical examination. The Prudent Layperson Standard exists to protect patients for this very reason.
“While we’re dismayed by United’s decision, we are not, unfortunately, surprised to see an insurance company once again try to cut its costs at the expense of necessary patient care,” said Mark Rosenberg, DO, MBA, FACEP, president of ACEP. “UnitedHealthcare is expecting patients to self-diagnose a potential medical emergency before seeing a physician, and then punishing them financially if they are incorrect.”
The timing of this new policy comes during a pivotal point in the nation’s efforts to combat COVID-19 and encourage vaccination. Throughout the pandemic, ACEP and other medical societies have been encouraging the public to not delay medical care, especially in case of an emergency. Scare tactics like this from insurance companies could severely undermine our collective efforts to get the virus under control.
“Over the past year, we’ve seen the devastating impact of when patients avoid treatment—including worsening health conditions and even death. This new policy will leave millions fearful of seeking medical care, just as we’re getting hold of the COVID-19 pandemic and trying to get as many people vaccinated as possible,” said Dr. Rosenberg.