United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

You’re assuming people know their sprained pinkie isn’t an emergency

Even a broken pinkie isn’t an emergency. All they can do is tape it to a splint unless it is totally mangled.

The average person does not necessarily know how to properly splint and buddy tape a broken finger. That’s why getting prompt medical care is appropriate.

But you can get that at urgent care!

IME, the quality of the care you receive at urgent care is far below that at the ER.

Prompt doesn't mean immediate. It can wait a day. a couple wraps of duct tape to the finger next to it is more than sufficient.

[Anonymous]

Elderly man, heart failure patient, recent history of acute kidney failure, sudden onset diabetes, and pancreatic cysts, presenting with sudden abdominal swelling with severe pain on a Saturday.

ER or not?

We consulted virtually with a relative who is a hospitalist doctor, who recommended ER. He was held over night for observation. No cause found for the pain and swelling, which went down the next day. He was found to be severely anemic and given two pints of blood.

Insurance refused coverage on grounds that a blood transfusion does not require a hospital stay. (We are appealing.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

You’re assuming people know their sprained pinkie isn’t an emergency

Even a broken pinkie isn’t an emergency. All they can do is tape it to a splint unless it is totally mangled.

The average person does not necessarily know how to properly splint and buddy tape a broken finger. That’s why getting prompt medical care is appropriate.

But you can get that at urgent care!

IME, the quality of the care you receive at urgent care is far below that at the ER.

Prompt doesn't mean immediate. It can wait a day. a couple wraps of duct tape to the finger next to it is more than sufficient.

Eff that idiotic sh*t. A broken bone of any kind should be properly attended to today. No, having a parent half-ass it with duct tape is not sufficient.

[Anonymous]

Anonymous wrote:What do you do if you get a nasty cut? Do you need to go to an ER for stitches or can it be done at an urgent care place? How in the hell would a regular person know this kind of cut/wound needs an ER visit, while this size cut can be done at an urgent care clinic. Oh, I'm sure UHC would argue that you could have gone to the urgent care clinic because your wound was only X cm long instead of Y cm.

Or consider this situation, several years ago my child was injured at her summer day camp. It involved her being hit in the head and a large cut. It would have taken me 45 minutes to get to the camp location to pick her up so they took her in an ambulance to the ER. No concussion but she did need stitches. The camp was obviously concerned with liability. Should they have not taken her to the ER?

Sad state of affairs.

BTW, I believe UHC posted record profits during the pandemic.

[Anonymous]

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.

I'm pretty sure the provider can send a bill if a visit is not covered. Balance billing is when your insurance doesn't pay the full amount and they come after you for the rest. There are situations where contracts prevent the provider from doing this. It may take your provider more than a year to invoke the clause on your behalf, but it's there!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

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.

Nope. Not at the ER. You can buddy tape it, or make a makeshift splint for the night. Urgent care the next morning.

This is why this policy is ever going to work out. Some of these people will try to rationalize every single possible scenario to justify why an ER visit was necessary. Even when it isn’t.

I'm a reasonably intelligent person. I would not know how to do this.

It's really not that hard. My teenager figured out how to do it last week when she broke a finger. Urgent care didn't have an x-ray so we waited until the next morning and went to another urgent care. Not saying all breaks should be treated like this, but a broken finger can wait for UC.

[Anonymous]

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)

It's a federal law called EMTALA.

[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.

+1.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

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.

Nope. Not at the ER. You can buddy tape it, or make a makeshift splint for the night. Urgent care the next morning.

This is why this policy is ever going to work out. Some of these people will try to rationalize every single possible scenario to justify why an ER visit was necessary. Even when it isn’t.

I'm a reasonably intelligent person. I would not know how to do this.

You don't know how to use athletic tape to tape two fingers together? Or how to drive to CVS, buy one of those finger splint things and put it on a kid's finger? You seriously are an actual adult that doesn't know how to do that?

You Tube or a first aid course may be in order for you.

[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).

lol no offense but this wasn't an emergency. your son is not ronaldo.

[Anonymous]

United is one of the worst companies.
Got some subrogation claim in the mail for care received over two years ago. Even after I sent detailed explanations about how I was not in a car accident...

[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).

FFS, that is not an emergency. If your motivation was a soccer game the next morning, you are part of the problem.

[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).

FFS, that is not an emergency. If your motivation was a soccer game the next morning, you are part of the problem.

+1 wtf, why would you think this was a good thing to use the ER for...

[Anonymous]

Anonymous wrote:United is one of the worst companies.
Got some subrogation claim in the mail for care received over two years ago. Even after I sent detailed explanations about how I was not in a car accident...

you're nicer than me, I would have just not responded. If they want money back, the statute of limitations has tolled already

[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.

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.

+1.

PP, you were absurd to go to an ER for a broken finger. Just to attend a soccer game? You're exactly the reason insurance companies do things like this. My God, the lack of self awareness is astounding.