United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

I wonder how much power united has to implement this. The major hospital corporations have near monopolies in a lot of markets and can just not agree to the change. Maybe before hospital consolidation they could force this through, but being in network at Nova or UHS is going to matter a lot more to United from a market perspective than it will to the hospitals

[Anonymous]

Anonymous wrote:As a United customer, I have zero faith that this will be implemented in any way that will be reasonable or not suck for patients. They are the absolute worst.

+1

There are few industries that I have less faith in that health insurance companies. They are true scum. They're going to start denying ER claims left and right.

People who speak fluent English, are well educated, understand the system, have time during their 9-5 desk jobs to make a phone call and sit on hold for 30 minutes, will be fine. They'll call, explain, get it covered. Everyone else is f*cked.

In the last year, I've had to make three different calls to UHC about bills that I got that I thought should be covered. They were quick to pay all of them once I called and explained. But it takes a lot of privilege to get to that point. This will just make it worse.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The problem with this is that it will not hit the pocketbook of the person who is inappropriately using the emergency room. The provider, who by federal law is required to perform an assessment, will not be reimbursed, but by contract will not be able to balance bill the patient.

+1 the ER abusers are mostly uninsured. This is just United being cheap as usual.

I don't see why the ER can't turn away patients and force them to the urgent care across the street. Being uninsured shouldn't matter. The law needs changed because it's bankrupting our hospitals and driving up costs on everything else in a hospital (like routine surgeries or childbirth)

How would that help? That's not going to change whether people pay, it will just switch the burden of non-payment from one provider to another.

Urgent care is like 1/10- 1/100th the price of an ER. With an ER you are paying for a hospital with specialists and operating rooms. It's better suited to gun shot wounds than strep throat.

[Anonymous]

It almost seems like hospitals could also have urgent cares on site. Sore throat...turn left. Trouble breathing...turn right.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I've seen this done through co-pays for awhile now. I just looked at my Aetna plan - an urgent care copay is $50 whereas an ER copay is $500 (waived if admitted). I haven't needed to fight yet over those situations where UC would not help and an ER is needed (i.e, broken bones)

I don't understand why urgent care wouldn't deal with a broken bone? They have Xray machines and will put you in a brace. Then you go to a doctor and get a cast later. Or if it's during normal business hours, just go straight to a doctor for an xray

Not all urgent cares have X-rays and not many are 24 hours. Found this out the hard way last week.

While I agree, UC would be my first choice for a broken bone, it may not always be an option.

[Anonymous]

Anonymous wrote:I think this is good. I think the majority of things that people go to the ER for could be handled at urgent care. Like sore throats, sprained ankles, even broken arms are better treated in a doctor's office, not ER. Less people in the ER helps everyone. Then the real cases can get through quicker.

I have Kaiser Permanente and LOVE their urgent care. When we have an emergency, we call the nurse line and ask what to do. I'm shocked at the emergencies that their urgent care can handle, but they've always done an excellent job. DH cut his finger nearly off (it was dangling and broken), they fixed it easily. He had an appointment with a specialist the next day too.

I think heart attack symptoms will always be covered. But as it is now, when they're overloaded it's hard to get care for heart attacks too. A couple of years ago a coworker died of a heart attack in the Reston ER waiting room.

I agree with all of this. I have a kid with a chronic life threatening medical condition that sometimes requires an ER visit. Cutting down the non urgent cases would make the process better for everyone.

[Anonymous]

Anonymous wrote:

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.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

I had bacterial pink eye, it came on while I was asleep and when I woke up the goop was so bad that I’d wipe my eyes and 3 minutes later I’d need to do it again because I couldn’t see. I walked to CVS, got in line for minute clinic. When the NP saw me she said “nope that’s outside what I can do. Go to urgent care or the ER.”

In my case, I had Uber on my phone, and at that point could see for a minute or two at a time so I could order one and went to Urgent care, but in other circumstances, I would have needed to go to what’s in walking distance.

So, yeah pink eye can be bad.

I have a friend with similar insurance whose kid woke up screaming that his chest hurt. Eventually diagnosed as heartburn and the claim was denied.

Goop in your eye sucks, but it’s not a life threatening emergency.

ER's aren't just for life threatening emergencies. If they were they wouldn't treat most broken bones.

My ability to see well enough to walk down the street (forget driving) or call 911 is pretty critical to my ability to parent my kids and support my family. When I woke up and that ability was rapidly disappearing, and the first urgent care provider I went to sent me away saying my situation was too bad, then yes, if the ER had been what I could access, it would have been a reasonable choice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

I had bacterial pink eye, it came on while I was asleep and when I woke up the goop was so bad that I’d wipe my eyes and 3 minutes later I’d need to do it again because I couldn’t see. I walked to CVS, got in line for minute clinic. When the NP saw me she said “nope that’s outside what I can do. Go to urgent care or the ER.”

In my case, I had Uber on my phone, and at that point could see for a minute or two at a time so I could order one and went to Urgent care, but in other circumstances, I would have needed to go to what’s in walking distance.

So, yeah pink eye can be bad.

I have a friend with similar insurance whose kid woke up screaming that his chest hurt. Eventually diagnosed as heartburn and the claim was denied.

Goop in your eye sucks, but it’s not a life threatening emergency.

ER's aren't just for life threatening emergencies. If they were they wouldn't treat most broken bones.

My ability to see well enough to walk down the street (forget driving) or call 911 is pretty critical to my ability to parent my kids and support my family. When I woke up and that ability was rapidly disappearing, and the first urgent care provider I went to sent me away saying my situation was too bad, then yes, if the ER had been what I could access, it would have been a reasonable choice.

ERs don’t really even treat broken bones. They stabilize them and tell you to go to an orthopedist.

[Anonymous]

Anonymous wrote:

Anonymous wrote:As a United customer, I have zero faith that this will be implemented in any way that will be reasonable or not suck for patients. They are the absolute worst.

+1

There are few industries that I have less faith in that health insurance companies. They are true scum. They're going to start denying ER claims left and right.

People who speak fluent English, are well educated, understand the system, have time during their 9-5 desk jobs to make a phone call and sit on hold for 30 minutes, will be fine. They'll call, explain, get it covered. Everyone else is f*cked.

In the last year, I've had to make three different calls to UHC about bills that I got that I thought should be covered. They were quick to pay all of them once I called and explained. But it takes a lot of privilege to get to that point. This will just make it worse.

I assure you that the bolded is not true. I may be educated and I may have the time. But the outcome is no different.

[Anonymous]

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

Yeah, this isn’t happening.

[Anonymous]

I wish United would do what Kaiser does and open well equipped 24/7 urgent cares. It does no good to tell someone to avoid the ER if you don't have somewhere else to redirect them

[Anonymous]

If they are unnecessary - why go the ER at all? Seems reasonable.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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 agree.

[Anonymous]

Anonymous wrote:I think this is good. I think the majority of things that people go to the ER for could be handled at urgent care. Like sore throats, sprained ankles, even broken arms are better treated in a doctor's office, not ER. Less people in the ER helps everyone. Then the real cases can get through quicker.

I have Kaiser Permanente and LOVE their urgent care. When we have an emergency, we call the nurse line and ask what to do. I'm shocked at the emergencies that their urgent care can handle, but they've always done an excellent job. DH cut his finger nearly off (it was dangling and broken), they fixed it easily. He had an appointment with a specialist the next day too.

I think heart attack symptoms will always be covered. But as it is now, when they're overloaded it's hard to get care for heart attacks too. A couple of years ago a coworker died of a heart attack in the Reston ER waiting room.

exactly. hospitals need to do their own triage to urgent care.