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CMS’ surprise billing rule puts United on the defense

Looks like CMS has put a damper on UnitedHealthcare’s latest attempt to deny coverage to its patients—and we’re not mad about it.

As you know, UnitedHealthcare recently laid out its plan to put in place a policy allowing them to retroactively deny emergency department visits if the treatment shows it wasn’t an actual life or death situation.

Now, in an interesting (and fairly immediate) turn of events, the Centers for Medicare & Medicaid Services (CMS) has proposed a surprise billing ban, hidden deep within a 400-plus-page document, that prohibit insurers from doing just that. In a Becker’s article, CMS states: the practice is “inconsistent with the emergency services requirements of the No Surprises Act and the ACA.” (High-five, CMS!)

This essentially makes United’s policy (which was initially set to take effect July 1) illegal, and in turn, puts United on the defense. Will the insurer take the volley? While United had thankfully pushed its plans to implement the policy “due to the strains of the pandemic,”, we pose the question – why implement it at all?

Further, is CMS’ action enough for United to officially take the proposed policy off the table? Or will they find another creative way to deny claims (a game of which they are MVPs, of course)?

What we’re hoping for? That CMS will continue keep a closer eye—and act quickly— to ensure patients get what they deserve.

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