Reply to United Healthcare will no longer cover uncecessary ER visits

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=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. [/quote]

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! [/quote]

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. [/quote]

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! [/quote]

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. [/quote]

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. [/quote]

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