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What United Healthcare’s New “Non-Emergency ER Visit” Policy Means For Your Small Business


The COVID-19 pandemic changed so many aspects of our daily lives, so it is no surprise that it changed how we think about healthcare and health insurance.  All but the wealthiest were in a position where a health problem not covered by insurance would be financially disastrous.  We started to talk about health services so essential that they should be available to all patients, regardless of ability to pay.  As COVID testing and vaccines became available, walk-in clinics and urgent care centers had their chance to shine.  Now that more than half the residents of Maryland and nearly that percentage of the population of the District of Columbia are fully vaccinated and the rate of new infections in the DC area has remained consistently low since vaccines became widespread, United Healthcare (UHC), one of the largest providers of health insurance nationwide, is tightening its purse strings and restricting the instances in which it will cover emergency room visits.  Specifically, on July 1, UHC will begin denying claims for emergency room visits for what it deems to be non-emergency reasons.  For patients, that means living with your pain and fear until doctor’s offices open on Monday morning.  From the perspective of a small business attorney, though, this decision offers businesses an opportunity to strengthen their relationships with clients and employees by helping patients avoid ER visits that their insurance will not cover.

If You Are a Healthcare Provider Who Accepts Payment Through UHC

As a healthcare provider, your financial solvency depends on your ability to collect payment from insurance companies and from patients.  If your UHC-insured patients are struggling with a huge ER bill after their insurance company denied the claim, it may affect their ability to pay their portion for services you provide them, too.  Your office staff should instruct patients by email, as well as face-to-face during visits, about what symptoms or side-effects to expect after undergoing a procedure or beginning a new prescription drug treatment, as well as about the signs of serious complications, for which they should call you.  Encourage them to use your after-hours emergency phone line.  This way, you can assure them that it is safe to wait until your office opens in the morning (but that they should go to the ER if they develop certain symptoms).  If the patient’s situation does warrant a visit to the ER, the patient’s medical records show that the patient went on your advice, so UHC should accept the claim.  Best of all, you are providing excellent services to your patients by being mindful of their finances as well as their health.

If You Are a Small Business That Provides UHC Coverage for Employees

If you are an employer who provides UHC coverage to your employees, you should also inform your employees of the changes.  Update your company’s employee web portal to make it easy for employees to find urgent care centers that will accept their insurance, and send out an announcement by email before the change goes into effect.

Let Us Help You Today

The last thing anyone needs as we begin to emerge from the COVID-19 pandemic is for healthcare to get more expensive.  A Washington DC small business attorney can help you develop policies related to employee health insurance coverage that are in your interests and those of your employees.  Contact Tobin O’Connor Concino P.C. for a consultation on your case.



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