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.

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.

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.

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

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

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.

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

To the extent that this incentivizes ERs to triage better and more quickly- I think it’s ok. They need to be able to quickly and cheaply sort through non-urgent matters.

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).

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.

The symptoms for a heart attack and a panic attack can be identical.

Thanks for sharing.

I wonder if this will apply for GEHA since it is so closely tied to UHC?

Gee, how could this possibly go wrong:

https://www.fiercehealthcare.com/payer/unitedhealthcare-may-retroactively-reject-non-emergent-er-claims-under-new-coverage-policy

So now patients will need to self diagnose in order to determine whether or not they need to go to the ER? There are many emergencies that have benign symptoms. We probably all know that there are going to be many cases as well that straddle a gray/borderline area where you could argue that a patient needed to go to the ER, yet UHC will determine that you didn't need to, therefore you'll be responsible for thousands. US healthcare sucks.