UnitedHealthcare says a new policy will reduce health care costs by reducing unnecessary emergency-room visits—but doctors warn there are some very obvious downsides to discouraging people from going to the ER. The policy the insurer is bringing in on July 1 will retroactively assess claims for emergency room visits, and those deemed to be nonemergencies will be subject to no coverage or limited coverage, depending on a patient's plan, USA Today reports. The American College of Emergency Physicians says the policy could result in people fearful of being on the hook for thousands of dollars not seeking emergency care when they need it, reports MedCityNews. The company insures around 30 million Americans.
The American Hospital Association has also urged UnitedHealth to reverse the policy, warning that imposing financial penalties could have a "chilling" effect on the decision to seek care. "Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency," AHA President and CEO Richard Pollack said in a letter to the insurer, per USA Today. UnitedHealthcare says claims will be assessed on factors including the problem presented and the intensity of diagnostic services performed. Company spokeswoman Tracey Lempner estimates less than 10% of claims will be rejected. The company says the policy will take effect for patients with employer-sponsored plans in 34 states and the District of Columbia; see the full list here. (A customer at Anthem, which has a similar policy, got a $12,596 bill after going to the ER with symptoms her mother, a retired nurse, thought could be a burst appendix.)