E+A’s VP of Compliance Comments on Recent Announcement Regarding Emergency Services Coverage

Posted by: Sarah Cartwright

United Healthcare’s announcement in 2021 that on January 1, 2022 they would not cover emergency services if they deemed the condition did not require an emergency service has ruffled some feathers, and rightly so! For emergency medicine and per Prudent Lay Person laws, the focus is the presenting problem and not always the final diagnosis. A person presenting with chest pain but a final diagnosis of bronchitis or chest wall pain requires a more extensive workup to rule out, diagnose and/or treat serious, life-threatening conditions such as myocardial infarction. Without that workup of the presenting problem, the patient could walk out of the ER door with an untreated life-threatening condition with serious consequences.

Many thanks to those organizations for speaking out against United Healthcare’s recent announcement to change their policy regarding Emergency Medicine services – ACEP, AHA, EDPMA, American Hospital Association to name a few.

UHC CEO has since stated that “there is no new policy regarding coverage criteria for emergency care being implemented on Jan 1, 2022.” He goes on to say that UHC “has no intention of implementing any such new policy for its fully insured business”.

If you are experiencing denials, Edelberg + Associates denials experts are here to partner with you to manage, appeal and fight for services rendered by your providers. We are here to compliantly increase revenue and minimize risk. Contact us today to find out how we can be your partner!

 

Author: Cheri Klein, CPC, CPCO – Edelberg + Associates, VP of Compliance

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