” UnitedHealthcare has one of the biggest care service provider networks in the nation,” stated Maria Gordon Shydlo, communications director for UnitedHealthcare, in an email. “We motivate our members to see these suppliers whenever they can as they have the lowest out-of-pocket costs. We acknowledge at times our members might require to see out-of-network companies and most of our strategies also offer out-of-network advantages in their service locations.”
Minnetonka, Minnesota-based UnitedHealthcare is no longer covering non-emergency services that members receive at out-of-network facilities beyond their service location.
This policy upgrade, which went into effect July 1, primarily impacts property treatment centers, inpatient rehabilitation and other non-hospital-based services.
Essentially, if a UnitedHealthcare member received rehab services in a center that is not in-network and is beyond their service location– specified by the payer as the state the member lives in addition to the surrounding states– it would no longer be covered. Members who have out-of-network benefits may continue to go out-of-network within their service locations.
The policy upgrade uses to both outpatient and inpatient care.
” UnitedHealthcare has among the largest care company networks in the country,” stated Maria Gordon Shydlo, communications director for UnitedHealthcare, in an e-mail. “We encourage our members to see these companies whenever they can as they have the least expensive out-of-pocket expenses. We recognize sometimes our members might require to see out-of-network companies and many of our strategies also provide out-of-network advantages in their service areas.”
Though the payer did not define which health insurance and the number of clients are currently impacted by this policy update, it said it prepares to extend the policy to every member enrolled with out-of-network benefits by mid-2022, Modern Healthcare reported.
UnitedHealth Group, UnitedHealthcares parent business, has courted debate in the past for rejecting non-hospital-based claims.
In 2019, a UnitedHealth subsidiary was found guilty of illegally rejecting psychological health and substance use condition claims. And last November, a federal judge purchased United Behavioral Health to reprocess about 67,000 protection claims.
Further, the current upgrade comes on the heels of a questionable policy alter the insurer announced last month. That policy modification would have made it possible for UnitedHealthcare to retroactively reject claims for emergency department check outs.
The statement was consulted with strong pushback, particularly from the American College of Emergency Physicians, which represents more than 38,000 emergency situation care companies. The policy could hinder clinical care and stop individuals from going to the ED even when they required to, the association stated.
In the middle of the furor, the payer stated on Twitter that it would delay the application of the ED declares policy “until a minimum of the end of the nationwide public health emergency situation period.”
Image: Minerva Studio, Getty Images
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