UnitedHealth’s new policy ends some non-emergency coverage

The UnitedHealth Group will no longer cover members ’non-emergency services from off-grid structures, as of July 1st.

The policy change will impact everyone from individuals seeking addiction treatment in day care facilities to those who want rehabilitative services after knee surgery in non-networked locations. Any non-emergent sub-acute emergency and outpatient services that are out of network will be affected, which essentially includes “abandoning” medical and behavioral care in qualified nursing facilities or residential treatment programs.

“UnitedHealthcare has one of the largest networks of care providers in the country,” a spokesman wrote in an email. “We encourage our members to see these suppliers whenever they can, as they have the lowest costs. We recognize sometimes that our members may need to see suppliers offline and most of our plans offer them as well. out of -Network benefits in their service areas. ”

But for patients whose conditions are not emergency, those out-of-network benefits are over. The company launched the change in a selected number of plans in July and expects to have the policy fully implemented for each enrolled member with out-of-network benefits by mid-2022.

A spokesman declined to say which plans are immediately affected and how many members the policy change will eventually have an impact on. UnitedHealth Group had 49.4 million subscribers at the end of its most recent first quarter on March 31.

Minnetonka’s health giant, Minn., Said it sent a letter warning Optum subscribers of the change in early June. But a report does WRDW-TV / WAGT-TV in Georgia he said UnitedHealthcare gave patients a week’s news that a nearby hospital would no longer be available online.

The insurer did not immediately respond to a question about whether coverage with University Health Practitioners and practices was tied to this policy, and UnitedHealthcare and the system based in Augusta, GA, eventually came to a close. interim agreement extending until November 30th.

The UnitedHealth Group’s policy change comes when the company tightens the nets where members can access services.

At the end of June, a group of plastic surgeons has hit society with a proposed class action, alleging that the nation’s largest insurer “routinely and consistently” has denied claims for a type of breast augmentation surgery required by cancer survivors despite a law federal government requiring them to cover the procedure.

A November 2020 analysis by the Bloomberg Act found at least seven insurers — including UnitedHealthcare — challenging these claims in court, saying these disputes were indicative of payers becoming increasingly aggressive about declining costs. and the reduction of supplier refunds. An expert said the litigation indicated that providers were trying to overburden insurers. Most of these disputes have been resolved through undisclosed settlements, including UnitedHealthcare.

Earlier in June, the company also unveiled a policy to retroactively deny emergency department claims. After complaints from the American Hospital Association, the American College of Emergency Physicians and other providers, the insurer quietly announced that it was pausing the policy through a customer service tweet.

That same month, UnitedHealthcare was also hit with a suit from a laboratory in New Jersey, which claimed that the insurer systematically denied payment of claims for 51,000 COVID-19 tests administered to its beneficiaries. Two days later, UnitedHealthcare announced that it will increase what it pays pediatricians and family medicine clinics to raise Medicare rates.

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