United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

Not a single doctor in the entire area could see him? You know orthos have walk-in hours, don’t you?

We called every doctor we knew to call. Feel free to recommend some who could have seen him sooner in case anyone we know has issues in the future. Did we call every doctor in the world, now but we got on our insurance directory and called everyone in network AFTER asking PCP for recommendations.

I already solved this for you, GO TO WALK IN HOURS.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

[Anonymous]

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

I’m the person who posted about taking her kid to the ER with the injured finger. The injury was caused when his hand jammed into the field finger tips first, with his own body and two other players falling on top of him all at once. He couldn’t move three of the fingers afterward, and was in very bad pain (he otherwise never complains about pain, even when he walked around on a broken ankle, so that was a concern on its own). Like I said, if UC had been an option, we would have gone there, but it wasn’t an option. Even if there were no game the next morning, we probably would have taken him. I’m fine with my decision, but you all can keep going with the judgment if you’d like. Doesn’t bother me.

[Anonymous]

Hmm well then I hope they're prepared to provide a detailed, itemized list of exactly which symptoms and problems merit an ER trip and which don't, and are sued to kingdom come when someone avoids the ER for non-typical heart attack symptoms and dies waiting for urgent care. The lack of transparency in the insurance industry is revolting, as is their entire parasitic business model. Mine, which is BCBS, regularly denies claims for my children's routine care. Why? They "don't know." It's a "glitch." We need medicare for all or the equivalent, like every other civilized country has.

[Anonymous]

One thing back lady and sprained finger lady show: yes, people really ARE this stupid, so the UH policy isn’t fair.

[Anonymous]

Whew! Ths thread. Just happy to not have United Health. Hope my insurance does not follow suit. I have no idea what is ER worthy or not. I also don't just willy nilly go to the ER but if I did think I needed to go I wouldn't want to have to risk harm for fear it would not be covered.

[Anonymous]

UHC denied our ambulance ride from VCH to Children's hospital after my kid had an unexpected seizure. They are impossible to work with.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m not saying I agree with UHC’s new policy, but I don’t know that it’s any different from what other insurers do. I have BCBS and they only seem to cover stuff in the ER if it turns out to have been an actual emergency. For example, I once went to the ER on a Sunday with a UTI that had gotten bad over the weekend. This was before UCs we’re all over the place, and Reiter-Hill wouldn’t give me antibiotics when I saw them that Friday because my rapid test had been negative. (So glad I’m no longer their patient.) Anyway, I knew I was taking a risk that it wouldn’t be covered, but I was just too miserable to care. Sure enough, BCBS made me foot the whole bill. Another time I went there because I was seeing flashes of light and thought it might be a detached retina. The ER physician couldn’t see my retina very well ended up sending me to an opthamologist. I paid the whole bill for that one, too.

Hmmmm. We have BCBS and DH is a hypochondriac and stays in the ER (not proud of this). They cover everything

for anything not life treating, Kaiser Tysons might as well be an er

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

Not a single doctor in the entire area could see him? You know orthos have walk-in hours, don’t you?

We called every doctor we knew to call. Feel free to recommend some who could have seen him sooner in case anyone we know has issues in the future. Did we call every doctor in the world, now but we got on our insurance directory and called everyone in network AFTER asking PCP for recommendations.

I already solved this for you, GO TO WALK IN HOURS.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

PP here. As you should be at this point, I just feel sorry for your DH he’s been walking around for a week unnecessarily in pain. But really that is just as much on him as you. This sort of learned helplessness annoys me.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

I’m the person who posted about taking her kid to the ER with the injured finger. The injury was caused when his hand jammed into the field finger tips first, with his own body and two other players falling on top of him all at once. He couldn’t move three of the fingers afterward, and was in very bad pain (he otherwise never complains about pain, even when he walked around on a broken ankle, so that was a concern on its own). Like I said, if UC had been an option, we would have gone there, but it wasn’t an option. Even if there were no game the next morning, we probably would have taken him. I’m fine with my decision, but you all can keep going with the judgment if you’d like. Doesn’t bother me.

I'm a mom, not a Dr. I would have taken my kid to the ER for that too, PP.

[Anonymous]

Anonymous wrote:One thing back lady and sprained finger lady show: yes, people really ARE this stupid, so the UH policy isn’t fair.

Former ER nurse here. FFS leave the back lady alone. CES is a serious issue which requires surgery pretty quickly to prevent further damage. I've had people directly admitted from the neurospine's office bevause of the seriousness of CES. Yeah I agree, if he sat at home for a week and then decided to go to the ER for a strain, that would be ridiculous. UC said to go to the ER and even if he got into a doctor, the doctor likely would have sent him straight to the hospital anyways.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

Not a single doctor in the entire area could see him? You know orthos have walk-in hours, don’t you?

We called every doctor we knew to call. Feel free to recommend some who could have seen him sooner in case anyone we know has issues in the future. Did we call every doctor in the world, now but we got on our insurance directory and called everyone in network AFTER asking PCP for recommendations.

I already solved this for you, GO TO WALK IN HOURS.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

PP here. As you should be at this point, I just feel sorry for your DH he’s been walking around for a week unnecessarily in pain. But really that is just as much on him as you. This sort of learned helplessness annoys me.

OP’s DH is an adult. Why are any of his decisions about his healthcare on her?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

Not a single doctor in the entire area could see him? You know orthos have walk-in hours, don’t you?

We called every doctor we knew to call. Feel free to recommend some who could have seen him sooner in case anyone we know has issues in the future. Did we call every doctor in the world, now but we got on our insurance directory and called everyone in network AFTER asking PCP for recommendations.

I already solved this for you, GO TO WALK IN HOURS.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

PP here. As you should be at this point, I just feel sorry for your DH he’s been walking around for a week unnecessarily in pain. But really that is just as much on him as you. This sort of learned helplessness annoys me.

First, he wasn't really walking. He can't really walk. Two, what did you want us to do? You point to walk in hours. There were none other than UC. Not sure where you live or what your insurance covers but it must be nice for YOU. We called in network providers and could not be seem before July. He went to UC. They gave him drugs and said to go to ER. He did not want to go to ER due to costs. We are working class. We don't have great insurance. If you do, be grateful and not rude to other people.

[Anonymous]

Anonymous wrote:Whew! Ths thread. Just happy to not have United Health. Hope my insurance does not follow suit. I have no idea what is ER worthy or not. I also don't just willy nilly go to the ER but if I did think I needed to go I wouldn't want to have to risk harm for fear it would not be covered.

Yup and that's exactly why blanket policies are awful. The average person has no idea what would be worthy through the eyes of their insurance. So they risk not getting a serious issue treated or winding up with a bill for thousands of dollars for getting a non serious issue looked at. It's stupid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My elderly neighbor went to er after minor surgery as he was having speech cognitive issues and stroke was a concern. MRI was negative for stroke. How could they possibly have ruled that out? That’s crazy. Most people avoid the er, waits are bad and it’s uncomfortable. It’s disgusting they are trying to trim expenses this way. We are well past the need for a profit cap on health insurance companies. They have proved they can make profit even during an international health disaster.

I'm getting pretty tired of insurance and pharmaceutical companies turning record profits while insisting they have to deny claims or raise the cost to consumers.

Insurance companies don't actually make significant profits and most BCBS plans are nonprofits.

Sure.

Health Insurance Premiums More than Double as Insurers Report Billions in Profit
https://www.bloomberg.com/press-releases/2020-09-02/health-insurance-premiums-more-than-double-as-insurers-report-billions-in-profit

" - Health insurance companies report doubling billion-dollar profits during
the pandemic in Q2 2020 compared to Q2 2019.
- Since 2009, employer health care premiums rose 57%, or an average of
$7,459 per year.
- United Healthcare reported a medical loss ratio of 70.2%, accounting for
its record profits in Q2 2020."

[Anonymous]

Former ER nurse here. One more thing. When did it become acceptable for insurance providers to act as medical providers. Don't think they went to any type of medical school!!! So when did it become okay for them to determine what is and is not medically necessary and what should and should not be covered. Oh I could go on and on about my beef with insurance companies!