Are Health Insurers Pushing Self-Diagnosis for Patients?

 When President Obama touted the Affordable Care Act in 2008, he promised that more Americans would have better healthcare. Recently, UnitedHealthcare, the largest insurance company in the United States announced a new policy decision to retroactively deny emergency room claims. If this policy change is allowed to stand, Americans may well wake up to learn that in an emergency situation they might just have to save themselves. 

UnitedHealthcare partners with more than 1.3 million physicians and care professionals, and 6,500 hospitals and care facilities. The scope of this policy has the potential to negatively impact millions of patients, most of whom, go to the emergency room because they believed it will save their life. 

A recent study by researchers at MIT Sloan School of Management and Boston Emergency Medical Services, states that during the COVID-19 pandemic, when many were afraid of going to emergency rooms for fear of catching the virus, many more Americans had heart attacks and other fatalities outside of hospitals where they could have received care. They also found that this happened most often in low-income neighborhoods. Is UnitedHealthcare going to retroactively pay these people because they did not use the emergency room?

This policy will affect millions of Americans in 35 states, including the Commonwealth of Pennsylvania, a place where I served as Human Services Secretary. During my tenure at the helm of the agency we partnered with providers to lead a successful effort to root out well over one billion dollars in healthcare and human services fraud, waste, and abuse, without impacting critical services like emergency room visits. If UnitedHealthcare or any other insurer is serious about efficiency and saving money, they might ask states and providers to partner with them to strategically reduce fraud and waste across the system. 

Physicians, hospitals, and other healthcare providers are on the front lines taking care of patients and are most aware of the waste in the system that exists. Without their critical input, cost cutting decisions will be made by desk job executives who have might have financial acumen but little in the way of patient care knowledge. The American Medical Association has characterized this policy as causing patients to “second guess their instincts that emergency care is needed.” Dr. Mark Rosenberg of the American College of Emergency Physicians meanwhile, criticized UnitedHealth for trying to “cut its costs at the expense of necessary patient care.”

What is even more puzzling about this policy is that emergency room usage was dropping prior to COVID-19. According to GIST Healthcare consulting visits to the emergency room “were down 27 percent in 2020, compared to 2019.” Although COVID-19 created an outlier, it is far from the norm. On the heels of what looks to be the end of this pandemic, a policy like this will strike fear in the most vulnerable patients. 

The good news is that public backlash has caused UnitedHealthcare to delay the original July 1^st launch date of this dangerous policy until “the end of the national public health emergency period.” While it may seem a welcome reprieve for American families struggling economically from the COVID-19 pandemic, the Public Health Emergency period is set to expire on July 20. Furthermore, if UnitedHealthcare plans to review old medical records searching for emergency room visits and charge patients retroactively, this and any other potential future delay would be meaningless as patients can just be back billed.

Insurance companies at their most basic level are meant to protect patients. Although streamlining emergency department efforts are critical and reducing expenditures across the board are imperative to fixing healthcare, a more prudent approach is to advance comprehensive reform together with the hospitals and providers to improve the entire system and make it more efficient and cost effective. If President Biden is serious about providing better healthcare for Americans, he ought to pay attention to how lopsided decisions like this could harm patients and turn professional medical diagnosis into self-diagnosis. Policies like this will punish patients physically as well as financially and erode any gains the United States has made to make it a healthier nation. 

Gary D. Alexander served as Health and Human Services Secretary in Rhode Island from 2006-2011 and Human Services Secretary for the Commonwealth of Pennsylvania from 2011-2013.

https://www.realclearhealth.com/articles/2021/07/07/_are_health_insurers_pushing_self-diagnosis_for_patients__111226.html