UnitedHealthcare in Minnetonka, Minnesota no longer covers non-emergency services received by members at out-of-network facilities outside of its service area.
This policy update took effect on July 1, and mainly affects residential treatment facilities, inpatient rehabilitation and other non-hospital services.
Essentially, if a UnitedHealthcare member receives rehabilitation services in a facility that is not in the network and not in its service area (defined by the payer as the state where the member lives and surrounding states), they will no longer be insured. Those with out-of-network benefits Members may continue to conduct out-of-network activities within their service area.
The policy update applies to inpatient and outpatient care.
“UnitedHealthcare has one of the largest healthcare provider networks in the country,” Maria Gordon Shydlo, UnitedHealthcare’s director of communications, said in an email. “We encourage our members to see these providers as much as possible, because their out-of-pocket costs are the lowest. We recognize that sometimes our members may need to see out-of-network providers, and most of our plans are still in their service area. Provide out-of-network benefits.”
Although the payer did not specify which health plans and the number of patients currently affected by this policy update, it said it plans to extend the policy to all members participating in out-of-network benefits by mid-2022 Modern Medical Report.
UnitedHealth Group, the parent company of UnitedHealthcare, has caused disputes in the past for denying non-hospital claims.
In 2019, a UnitedHealth subsidiary was found guilty of illegally denying mental health and substance use disorder claims.In November last year, a federal judge ordered joint behavioral health Reprocess the appointment 67,000 insurance claims.
In addition, the latest update comes after a controversial policy change announced by the insurance company last month.This policy change will enable UnitedHealthcare to Retrospective denial of claim Used in emergency department visits.
The announcement was strongly opposed, especially from the American College of Emergency Physicians, which represents more than 38,000 emergency care providers. The association stated that the policy may hinder clinical care and prevent people from going to the emergency room when needed.
In a panic, the payer tweeted Will delay implementation ED’s claim policy “at least until the end of the national public health emergency.”
Photo: Minerva Studio, Getty Images
