UnitedHealthcare and the non-emergency emergency… Who Decides If You Need To Visit The Emergency Room?

UnitedHealthcare delayed a controversial decision to retroactively declare treatment in an emergency room not an emergency.

UnitedHealthcare and the non-emergency emergency…

Who Decides If You Need To Visit The Emergency Room?

On the latest edition of the Houston Healthcare Initiative podcast, respected neurologist and Houston Healthcare Initiative founder Dr. Steven Goldstein discusses the proposed UnitedHealthcare policy of after the fact review and in some cases possible denial of  some emergency room visits. The Houston Healthcare Initiative podcast can be heard on: SoundCloud, iHeartRadio, Stitcher, Backtracks, LibSyn, Soundcloud, or the website at www.houstonhealthcareinitiative.org.

Declaring the Emergency, a Non-Emergency

UnitedHealthcare is the nation’s largest health care insurer. In early June 2021 UnitedHealthcare announced that it would change how they assess emergency department claims, and thus allow ‘United’ to retroactively deny claims it deemed “non-emergent” or not an emergency. The aim is for the insurance company and their customers to save money, but others say the consequences could be more costly or even deadly. The new policy was originally scheduled to begin on July 1, 2021 but after a wave of criticism from among others, the American College of Emergency Physicians, United backed off and later said they would wait until the pandemic was past to make a decision about this decision.

Bad Policy With Usual Solutions Tried

Like the American College of Emergency Physicians Dr. Goldstein also believes this policy is unwise. “The answer is not to retroactively deny payment for ER care already rendered,” he told his listeners. “What this does is force the hospitals to refuse care for “non-emergency care” as defined by UnitedHealthcare. However, this is not practical because the hospital is more afraid of a potential lawsuit if a patient is refused care and has a poor outcome as a result. The patient then will be stuck with a large bill that cannot be paid.”

Dr. Goldstein states this is another example of an insurance company trying to “manage care.” “They (insurance companies) see a problem, namely they think that Emergency Room services are over-utilized and think they can manage the problem,” Dr. Goldstein said. “They try their usual method of operation and simply deny payment.”

On The Other Hand

UnitedHealthcare claims there are big problems with the misuse of emergency rooms which costs the U.S. healthcare system roughly $32 billion annually. UnitedHealthcare states that misuse typically manifests as patients seek out costly care for minor ailments that could be addressed through other avenues like an urgent care type of clinic. According to the UnitedHealthcare web site, “two-thirds of hospital ED visits annually by privately insured individuals in the U.S. – 18 out of 27 million** – are avoidable.”

Does UnitedHealthcare Have A Point?

Dr. Goldstein stated that United had a point “if the point is that healthcare administered in an emergency room is too expensive.” But he also point out, “UnitedHealthcare negotiated the prices they pay with the hospitals. If it is too expensive, why did they negotiate such a high price?”

About the Houston Healthcare Initiative Podcast

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To hear the podcast go to:

Dr. Goldstein insists that for the health and welfare of the American public, the congress must pass reforms that limit the influence of the pharmaceutical industry and its lobby.

Unexpected Emergency Room Bills Add To Patient Ills

Patients may go to the hospital designated as in network by their insurance, but the doctors who treat them may not be part of that network. This is one of the main reasons for big bills even among those who have health insurance. Patients rarely have any say about who treats them, especially in the case of accidents where they are incapacitated. This is the message that Dr. Steven Goldstein has for podcast listeners this week. The Houston Healthcare Initiative CO-OP podcast can be heard on Soundcloud, Google Play, and iTunes. The podcast and much more information is available from the Houston Healthcare Initiative CO-OP website: www.houstonhealthcareinitiative.org. Or click here to listen:

Unexpected Emergency Room Bills Add To Patient Ills

Wide Awake Nightmare

Imagine leaving the hospital after recovering from an accident, illness or some other unexpected and unwelcome ailment thinking that the worst is over, but then getting a walloping big bill to pay even with really good health insurance. It’s a scenario that plays out ever day and one that respected Houston based neurologist and founder of the Houston Healthcare Initiative CO-OP thinks the public has a right to know.

The out-of-network billing problem exists in part because insurers have sought to rein in costs by shrinking their provider networks and steering patients to less expensive doctors and hospitals. But some specialists and provider groups have deliberately stayed out-of-networks because they can make more money.“This is especially true in emergency rooms, where the patients’ inability to choose their doctors provides a strong incentive for physicians not to cut deals with insurers,” Dr. Goldstein said.  “For example, a 2017 study on surprise bills by Yale University researchers reported that one group of emergency room physicians that exited networks to bill as out-of-network providers charged twice as much for care as their ERs used to charge. It’s ridiculously unfair.”

Facts About Bad Surprises

Unwelcome E.R. and hospital bill surprises are not unusual and that is the disappointing part. On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. “Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation,” Dr. Goldstein told his audience. “But the news gets worse because the same study found that when a patient is admitted to the hospital from the emergency room, there’s a higher likelihood of an out-of-network charge. As many as 26% of admissions from the emergency room resulted in a surprise medical bill.”

Why We All Tolerate This

When asked about the reasons the public chooses to tolerate this, Dr. Goldstein replied, “the medical and insurance industries have trained us all to think that there is but one choice for us and that is to work with them, exclusively, and that there are no alternatives available for anyone not old enough to get Medicare.” There are alternatives, like the one we have at the Houston Healthcare Initiative CO-OP, but so few are aware of this and other similar organizations that we all simply take and pay for what is available.”

To learn more about the Houston Healthcare Initiative CO-OP please visit the web site atwww.houstonhealthcareinitiative.org