June 11, 2021
UnitedHealthcare Announces Retrospective Denials for Select ED Visits
In an effort to curb non-emergent ED utilization, UnitedHealthcare (UHC) has announced a new coverage policy for patients presenting at a hospital ED. Starting July 1, 2021, UHC will reserve the right to retroactively apply “no coverage or limited coverage” for claims that the insurer determines were not for true emergencies. According to the policy briefing released by UHC, the insurer will consider multiple factors including the initial cause of the patient’s presentation at the ED, the diagnostic services they received and complicating factors like chronic conditions.