Going To The Emergency Room Just Got More Expensive For Insured Patients

When you are sick, should you go to the emergency room or wait until Monday morning, when doctors’ offices reopen?  On the one hand, some common and non-specific symptoms can be signs of life-threatening conditions where prompt medical treatment is your only hope for survival.  Is it just a stomach ache or appendicitis?  A headache could just be a sign that you are tired or hungry, but it could also be the first symptom of something terrifying, like a stroke or encephalitis.  On the other hand, going to the emergency room is prohibitively expensive if you do not have health insurance and sometimes even if you do.  Unfortunately, a recent change to coverage guidelines could make emergency room visits even more expensive for patients insured by United Healthcare.  If you are experiencing financial hardship because of medical debt, contact a Miami debt lawyer.

Read the Fine Print About Insurance Coverage for Emergency Room Visits

Owning a house with a paid off mortgage is the surest sign of financial stability, but being covered by employer-provided health insurance is a close second.  The best employer-provided health insurance plans charge you a flat fee, usually less than $200, for an emergency room visit.  (You might still get big bills from the out-of-network doctors who treated you in the ER, but one big bill and one affordable bill is better than two big bills.)

On July 1, 2021, United Healthcare added a loophole in its policy of charging a flat fee for emergency room visits.  It announced that it has the right to deny claims for emergency room visits if it determines that they were for non-emergency reasons.  The company instituted this change when it realized that, every year, it spends billions of dollars on emergency room claims that would have been much cheaper if the patient had just driven a few more miles down the road to an urgent care clinic or waited until morning when outpatient doctors’ offices reopened.

This could mean that more patients will wait until they are in dire straits before they seek treatment (which means, in the long run, that their treatment will be more expensive) and that patients who go to the ER rather than risking their health will be faced with insurmountable medical debt.  The good news is that the patients affected by this change already have insurance, which means that they already have an ongoing relationship with a primary care physician or one or more specialists.  The best way for patients insured by UHC to avoid a claims denial for an ER visit is this: if you are debating whether to go to the ER on the weekend or wait for a doctor’s appointment, call your primary care doctor or other treating physician’s after-hours answering service.  If the doctor calls back and tells you to go to the ER, then your medical records indicate that the doctor considers it an emergency, so there is less chance that UHC will reject your claim.

Don’t Let Medical Debt Ruin Your Finances

A debt lawyer can help you get out from under the mountain of medical debt that is crushing more than half of American households.  Contact Nowack & Olson, PLLC for assistance.

Resource:

msn.com/en-us/health/nutrition/unitedhealthcare-to-limit-coverage-of-non-emergency-visits-to-er/vp-AAKPU32