ED Coding and Reimbursement Alert

Question: When will UnitedHealthcare begin its new policy of denying ED facility visits that it classifies as “non-urgent?”

Texas Subscriber

Answer: The good news is that United is not currently going to implement the plan to halt pay for non-urgent ED visits, which had been scheduled for a July start date. The payer said that it will hold off on the plan to start the policy until after the pandemic ends.

As part of its proposal, the company was essentially asking patients to make self-determinations of their diagnoses after evaluating their conditions. If, for example, a patient believes he is having an asthma attack and the ED physician diagnoses him with seasonal allergies, that could potentially be a reason for denial, under the proposed policy.

“While it’s a relief that patients will get a short-term reprieve, United Healthcare is not getting rid of this dangerous policy — only delaying it,” said Dr. Mark Rosenberg, president of the American College of Emergency Physicians, in a statement. “However, medical emergencies will continue to happen beyond the pandemic, and ACEP remains committed to advocating on behalf of patients and their ability to seek emergency care when they think they need it.”

Keep an eye on ED Coding Alert for updates on whether the policy is reinstated in the future.