United Healthcare will no longer cover uncecessary ER visits

[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).

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

Ronaldo would have had sense enough to have a trainer tape his finger, not go to the ER like some entitled dolt.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Half the problem is people taking babies and children to the ER for any fever (not just dangerously high) and for things like earaches and stomach aches. People freak out over their kids. The first step should be to call the ped’s after hours number and then only go to the ER if they say you need to.

Every time we called the afterhours number, they told us to go to the ER.

this, if they can't take you they say to go to the ER every single time

You need a new ped. In our 13 years at our ped, we've called the on-call doc at least 4 times after hours and never once been sent to the ER. We were told watch for X and Y and if Z happens then go to the ER. Otherwise come to the office tomorrow.

[Anonymous]

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.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Half the problem is people taking babies and children to the ER for any fever (not just dangerously high) and for things like earaches and stomach aches. People freak out over their kids. The first step should be to call the ped’s after hours number and then only go to the ER if they say you need to.

Every time we called the afterhours number, they told us to go to the ER.

this, if they can't take you they say to go to the ER every single time

You need a new ped. In our 13 years at our ped, we've called the on-call doc at least 4 times after hours and never once been sent to the ER. We were told watch for X and Y and if Z happens then go to the ER. Otherwise come to the office tomorrow.

This is how our ped handled it as well. Only one time did we need to go to the ER based off of what the on call doc had told us to watch out for.

[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.

NP.
I'm not sure you understand. The child might have felt fine and wanted to play. What could a mother do? Tell him no? [/s]

[Anonymous]

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.

[Anonymous]

I wish we had a universal system with an optional private system

I've noticed some people expressed vaccine hesitancy due to lack of coverage for adverse events

[Anonymous]

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.

Im pretty sure they aren't going to deny that visit because the symptoms are ER worthy. Just because he turned out fine doesn't mean what he presented with wasn't an emergency.

[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.

Seriously? Take tape. Tape injured finger to finger next to it. And then skip the soccer game until you have it looked at. None of that is an emergency.

[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.

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!

[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.

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.

[Anonymous]

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.

[Anonymous]

My DD broke her arm at the playground. Are you saying she should have gone to urgent care and not the ER? She was 7, it was a compound fracture, she was taken to the ER and had surgery that night. But United Health and DCUM expected me to tape it up and wait for her pediatrician? Since when are fractures not ER situations. Her bone broke through her skin/arm. Her arm was literally dangling and she was screaming like a mad woman and then eerily stopped (we were told she went into shock) but sure United. No ER.

[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.

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!

Your DH is a problem. He’s had this issue a week, he could easily have gone to his GP or a back specialist, ortho clinics have acute hours. ER is not the place for this kind of thing.

[Anonymous]

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.