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UnitedHealthcare may deny coverage for emergency visits

“Unnecessary emergency room use costs nearly $ 32 billion a year, increasing healthcare costs for everyone,” the company said in a statement Monday. “We are taking steps to make care more affordable, encouraging people who do not have a health emergency to seek care in a more appropriate setting, such as an emergency care center. If one of our members receives emergency room care for a non-urgent problem, such as pink eye, we will reimburse the emergency facility according to the member’s benefit plan.

During the pandemic and during months of lockdown, non-Covid care, from knee surgeries to mammograms to emergency room visits, has plummeted. Insurers, including UnitedHealth Group, the company’s parent, have posted strong profits throughout the crisis. While some experts feared delays in care worsen patients’ condition, others argued that the decline could provide evidence of unnecessary care like screenings.

United’s initial move was seen by some critics as a message to hospitals.

“They see this as a way to gain the upper hand in their perpetual battle with providers,” said Jonathan Kolstad, health economist at the University of California at Berkeley.

It was the latest example of conflict between the insurer and doctors and hospitals, said Michael R. Turpin, a former United executive who is now executive vice president of USI, an insurance brokerage firm that helps businesses find coverage. More recently, United’s sparring with anesthesiologists has led to legal action against a major physician-owned firm backed by private investors, and hospitals are complaining that United has adopted other policies that make it difficult to cover their care. for patients.

A few consumers are already battling insurers and some providers over billing for Covid vaccines, prompting the federal government to remind participants that it is illegal to charge these costs to patients.

There is also growing evidence that some of the people who did not go to the emergency room during the pandemic might have been better off seeking treatment. A recent study in Health Affairs conducted by researchers at the MIT Sloan School of Management, in conjunction with Boston Emergency Medical Services, found an increase in heart attacks occurring outside the hospital, particularly in neighborhoods. low income.

People delaying care may be among the already most vulnerable populations, according to a study by researchers from the Centers for Disease Control and Prevention, which looked at the makeup of people who said they delayed care. “Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, people with underlying health conditions, black adults, Hispanic adults, young adults, and people with disabilities.” , wrote the researchers.

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