When even the headline of one of Yahoo News’s rotating lead stories notes “backlash” against a decision made by a health insurer, it’s not a good week for the company’s image. However, UnitedHealthcare’s announcement that it’s going to start looking long and hard at emergency room visits—and denying or reducing payment on claims deemed to be nonemergent—could wind up benefiting the urgent care industry. In a network bulletin posted on its website, UHC announced it plans to “enhance [their] capabilities to assess emergency department facility commercial claims to determine if the ED event was emergency or nonemergent.” Visits will be evaluated based on the patient’s presenting complaint, the intensity of diagnostic services, and “other patient complicating factors and external causes.” The notice specified that the plan will be rolled out in certain unnamed states starting July 1, and expanded in months to come. UHC cited annual ED claims amounting to almost $32 billion as the instigating factor. Whether we wind up seeing EDs turning patients away remains to be seen, but once this news is absorbed it may spur busy primary care physicians and pediatricians to refer more patients to urgent care instead of the ED. An article published online by MedPage Today called out urgent care as a likely destination for such patients, in fact.

UnitedHealthcare Will Stop Covering Some ED Visits. Could Urgent Care Benefit?
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