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June 17, 2021

United Healthcare Temporarily Halts Controversial ED Coverage Policy

A few days after United Healthcare (United) provided public notice of a new emergency department coverage policy which as of July 1 would have permitted United to retroactively deny coverage of emergency department visits for services the insurer determines did not require emergency level care based on the patient’s eventual diagnosis, the insurance giant announced it has temporarily halted implementation of the policy until at least the end of the national public health emergency. This move likely comes in light of the pushback United received from healthcare provider organizations, such as the American Hospital Association (AHA). AHA and other provider groups  saw the move as a means to dissuade individuals from seeking emergency care, and as a way to circumvent the prudent layperson standard which requires health insurers to cover emergency services based on the patient’s symptoms and not the patient’s eventual diagnosis. The American College of Emergency Physicians initiated a lawsuit in 2018 against Anthem Blue Cross and Blue Shield for implementing a similar policy.