UnitedHealthcare Clarifies No Imminent Changes to Coverage Criteria for Emergency-level Care

UnitedHealthcare, following several communications from the AHA to its leaders regarding an apparent change in its coverage criteria for emergency services, has clarified that it will not be enacting such changes at this time.

In a letter responding to AHA late yesterday, UHC CEO Brian R. Thompson wrote, “There is no new policy regarding coverage criteria for emergency care being implemented on January 1, 2022… Further, UnitedHealthcare has no intention of implementing any such new policy for its fully insured business.” Thompson acknowledged that AHA’s letter had made it clear that language in the December Bulletin on coverage determination guidelines (CDG) had created “confusion” and that AHA’s feedback spurred UHC “to be clearer regarding our intent.”

Thompson added that UHC would be updating its CDGs “to remove the language added in the December Bulletin as well as language that was added earlier in 2021 regarding coverage criteria for emergency services.”

AHA is pleased with UHC’s response and will continue to attempt to work with the insurer to ensure that coverage criteria are appropriate and well-defined.

FURTHER QUESTIONS

If you have questions, please contact AHA at 800-424-4301.

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