The Alliance of Specialty Medicine wrote to Brian Thompson, the CEO of United Healthcare, to protest his proposed (and since withdrawn) policy that would have retroactively denied coverage for emergency care. Patients often enter the emergency department precisely because they don’t have the expertise to determine whether a medical issue needs immediate care. Subjecting their best judgment made in real time to a retroactive review by experts amounts to nothing more than an excuse to deny care.

The Alliance believes the policy attempts to circumvent UHC’s violation of the prudent layperson standard by allowing a facility to submit an “attestation” for any emergency event that is retroactively determined by UHC to be non-emergent. Such an attestation creates yet more administrative burden on providers with no benefit to patients. Even more importantly, a retroactive attestation by the provider is incompatible with the prudent layperson standard, which rests on patients’ decision-making at the time they seek emergency care.

The letter concludes with the Alliance urging a permanent withdrawal of the policy.

Alliance Letter to United Healthcare

 

The Alliance Staff

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