AHA Expresses Concern with UnitedHealthcare’s Coverage Criteria Change for Emergency-level Care

Special Bulletin
December 29, 2021

The AHA today expressed concern to UnitedHealthcare (UHC) regarding its recent announcement to change its coverage criteria for emergency-level care and requested that the plan rescind this new policy.

Beginning Jan. 1, 2022, UHC will begin reviewing claims for emergency services to evaluate whether the patient should have accessed care in the emergency department. If UHC believes that emergency-level care was not warranted, it may deny the claim.

In a letter today to UHC regarding the new policy, AHA President and CEO Rick Pollack wrote, “We are very concerned about the impact it will have on patients and their providers. Like its predecessor, this new policy will make patients much more reluctant to seek needed emergency care out of fear of a coverage denial…. The policy also will place an incredible burden on hospitals’ clinical workforce at a time when the demands on them are already simply extraordinary. It will pull clinicians away from the bedside to collect, review and submit paperwork, often multiple times over, to try and obtain coverage for their patients.”

UHC last June delayed implementing a previous version of this policy after concerns raised by the AHA and others. At the time, UHC said publicly that it would not implement a new emergency service coverage policy until “at least the end of the public health emergency.” However, the new policy would go into effect as COVID-19 case counts are rising rapidly across the nation.

Read the full AHA letter here.


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