Reply to United Healthcare will no longer cover uncecessary ER visits

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

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).[/quote]

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. [/quote]

Knowing if the finger is fractured is an urgent situation, soccer game or not. If the someone just goes about their business with a fractured finger that isn’t splinted or otherwise stabilized, it’s easy to injure it further in a way that displaces the bone or otherwise requires far more serious treatment, including surgery, that could have been prevented by having it checked right away.  Leaving it until the next day (or possibly a day or two after that, since many urgent cares are closed on Sundays) is a risk.

This is not the situation that is driving up the cost of medical care, because it’s not that often that someone has an issue that needs to be addressed right then, would be suitable for urgent care, but urgent care is closed.  The people driving up costs are the ones who go to the ER after they’ve been sick with strep for three days because they didn’t want to take off work during the week to see their doctor and/or don’t want to drive further to an UC.[/quote]

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