“Not allowed to retroactively deny emergency department (ED) claims? Well, then we just won’t pay out-of-network (OON) claims anymore.” We imagine this was idea that got thrown out at the latest meeting of the minds at UnitedHealthcare HQ.
Point in case: a recent article in Modern Healthcare describing UnitedHealth Group’s surprising end to some out-of-network coverage if care is not delivered “in the patients’ coverage area.” Even providers are stumped at this decision! The article covers how United is working to limit types of care it is willing to pay OON claims for, specifically based on coverage area. We already know that United wants to retroactively deny ED claims and that some United cancer patients might be denied claims for post-cancer surgery, and now, and United is targeting high-cost mental and behavioral healthcare. What could possibly be next?
The main issue with denying care based on coverage area is perfectly encompassed in substance use disorder – and not like we’re in the midst of an opioid crisis, or anything. “In the case of substance use disorder, patients frequently leave their coverage areas for treatment, because removing themselves from their current environments can result in better clinical outcomes,” says Zachary Rothenberg, a lawyer who represents a number of behavioral health providers.
Beyond addiction treatment, consider the fact that the United States is currently in a severe behavioral health crisis exacerbated by the pandemic (think: major increases in anxiety, youth depression and adult suicide ideation). We have to ask, with a shortage of many of those critical behavioral health facilities and providers, where will inpatient psychiatric care patients turn? And of all moments, is United seriously trying to make accessing mental healthcare more difficult now?