Switch to ADA Accessible Theme
Close Menu

United Healthcare Institutes New Policy of Denying Claims of Patients Who Visited the Emergency Room for Non-Emergency Reasons


Among people without health insurance, avoidance of medical treatment has become a national epidemic.  When people get sick, they often assume that the medical bills they will have to pay out of pocket will be more painful than the illness itself, so they stay away from doctors and hospitals until their symptoms become unbearable or, just as often, because missing work because of their illness is just as financially deleterious as medical bills.  Uninsured patients are more likely to visit the emergency room, not only because they do not have a primary care doctor, but also because the pain and the fear of delaying treatment any further often reach critical mass in the middle of the night.  You might assume that, just because you have employer-provided health insurance, you have been spared this nightmare.  You can simply go to the ER and then receive a bill for the amount specified on your insurance card for ER visits (plus out-of-network doctors’ fees and expensive lab tests, but that is a different story).  Patients covered by United Healthcare may soon find themselves having to argue with their insurance company on a case-by-case basis about what counts as an emergency.  If your insurance company has denied your claim for an ER visit, contact a Philadelphia insurance claim denials lawyer.

Is That Stomachache a Real Emergency?

Beginning on July 1, 2021, United Healthcare will deny claims related to emergency room visits if the company determines that the visit was for a non-emergency purpose.  The company has instituted this measure because it reportedly has been paying hospitals billions of dollars per year for services that patients could have received at a much lower price if they had simply waited until morning to visit their primary care doctor or driven a few more miles to the nearest urgent care clinic.

Critics of the policy claim that it will add patients with UHC coverage to the growing group of patients who delay visiting the ER because they are worried that they will be stuck with an unaffordable bill disproportionate to the severity of their illness.  If you get a stomachache on Friday night, in most cases it is safe to wait until Monday morning and then go to the doctor if you are not feeling better.  What if the stomachache is appendicitis?  Your illness can become much more severe over the weekend.

If you are worried that your symptoms are being caused by something serious, you should seek treatment.  If urgent care clinics are open in your area, go to one of those, because they are less expensive (and if they then refer you to the ER, it is the doctor’s opinion, not just yours, that your illness is an emergency).  If there are no urgent care clinics open near you, go to the ER.  If your insurance company denies the claim, your insurance claims denial lawyer can help you.

Contact an Attorney for Help Today

If your health insurance company has unjustly denied your insurance claim for an emergency room visit, a Philadelphia insurance claims denials attorney can help.  Contact Louis S. Schwartz at CONSUMERLAWPA.com to set up a free, confidential consultation.



Facebook Twitter LinkedIn