United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

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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!

You should have called your insurance company and asked them to help you find a specialist in network who would see him. People who can't navigate systems shouldn't call other people moronic.

NP-I have UHC, which required my son to find an outpatient infusion center for Remicade. I consulted the provider directory and none were listed. I called UHC and was told to consult the provider directory. I told the woman none were listed and she repeated that I should consult the provider directory. I can navigate systems and I’m calling you a moron.

[Anonymous]

lmao. it is clear who the insurance company lobbyists itt are.

US healthcare sucks. Period.

[Anonymous]

Anonymous wrote:lmao. it is clear who the insurance company lobbyists itt are.

US healthcare sucks. Period.

+1. We used to be on them when I worked at a white shoe law firm. So glad I changed careers and insurance.

[Anonymous]

Anonymous wrote:

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.

+1 - and she came back and said they had tried to find care, but even their insurance couldn't help them. Which is why this UHC policy is a bad idea. Things that sound solvable by primary care might actually be emergencies, especially if you can't get into primary care, or in this case, an ortho!

[Anonymous]

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Anonymous wrote:I sense a lot of ER doctors leaving united's network and just billing patients personally

This is ignorant. ER docs have a salary.

It’s the hospital corporations that get $$$$$ from expensive ER visits.

ER docs have a salary paid by an employer who is almost never the hospital. Most hospitals contract out their ERs. Those companies now have a lot of incentive to be out of network

And hospital corporations have way more power than “employer” to decide who they will contract with. If your talking about locums, that is not the norm for the majority of employees at most hospitals.

Either way the original poster of this back and forth stated ER docs would begin billing personally. That is false.

And this is a good change. There is too much waste in the ER with non-emergency visits. They train for emergencies and prefer them. They don’t want to be a primary care doctor.

This will ease the strain on our healthcare system and should be the case across the board in order to ease taxpayer dollars.

If it can wait until your primary care is open, wait. If it can’t but isn’t ER/Ambulance worthy, go to urgent care.
If you suspect life and death or severely broken bones, go to the ER.

If it's really about "easing the strain on our healthcare system" and not about profits, then it needs to start not with private insurers, but the REAL abusers in bulk of the ER -- people with Medicaid.

[Anonymous]

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Anonymous wrote:The article references things like pink eye. Do people really go to the ER for pink eye?

I think the heart attack/panic attack would be covered as it could be something ER-worthy.

There can be close calls. Two weeks ago we took our son to the ER for what turned out to be a sprained finger, but could have been a fracture. We tried to go to urgent care instead, but they were all closed at that hour on Saturday night. Under other circumstances we would have waited until the next day to get it checked at urgent care, but he had a 7am soccer game the next morning and we wanted to know if there was a fracture in case he said he felt well enough to play.

We have UHC, and by the following Wednesday (holiday weekend, so no mail moving Monday), we already had a mailed notice from UHC reminding us UC was an alternative to the ER. I just got the EOB last night and hadn’t looked at it yet before I saw this post. Fortunately they’re covering the visit, but I could have seen them retroactively denying it under this new policy (which I was not aware of before now).

I don’t mean to sound like a jerk, but IMO this is exactly the type of visits they mean to prevent. Having a soccer game the next day is not an emergency.

I have to agree. What you describe is not an emergency.

DP. It could have become a far more expensive medical event if they didn't get it checked out, the kid said he felt better the day and played, and then fractured it further and displaced the bone, requiring surgery. Even if there weren't a soccer game the next morning, pp was correct to get it checked out that night if it was a possible fracture.

But of course none of these dire scenarios need to occur, because even if little Timmy really really wants to play with a badly injured finger, his responsible parents can say no.

[Anonymous]

Looks like they're delaying implemention of the policy: https://www.uhcprovider.com/en/resource-library/news/2021-network-bulletin-featured-articles/0621-ed-facility-commercial-claims.html

Thank God.