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News In The Insurance Industry

UnitedHealthcare temporarily reverses ER claims denial policy after backlash

Pressure from industry groups caused the insurer to balk, though the policy is still slated to take effect when the pandemic ends.

UnitedHealthcare, the nation's largest health insurer, has backtracked on a proposed policy retroactively rejecting emergency department claims.

The policy, which was slated to take effect on July 1, meant UHC would evaluate ED claims to determine if the visits were truly necessary for commercially insured members. Claims deemed non-emergent would have been subject to "no coverage or limited coverage," according to the insurer.

The move, however, resulted in plenty of backlash. Go here to read further........... https://www.healthcarefinancenews.com/news/unitedhealthcare-temporarily-reverses-er-claims-denial-policy-after-backlash

July 29, 2021; Jeff Lagasse, Associate Editor: Healthcare Finance

Aetna spat with HCA could leave Florida patients looking for new doctors

The CVS-owned insurance company and one of Florida’s largest hospital chains are at loggerheads over new contract for reimbursement of medical care.

Published Sept. 9|Updated Sept. 10

By

Christopher O'DonnellTimes staff

Thousands of Floridians with Aetna health insurance could be looking for new doctors by next week due to a dispute between the insurer and HCA Healthcare over reimbursement rates.In a letter sent to customers, Aetna said that HCA hospitals will no longer be considered in-network in Florida and patients could end up having to pay if they continue to get treatment there.

The warning is the result of the insurance company, which is owned by pharmacy giant CVS, and HCA failing to agree terms for a new reimbursement contract. The current contract for hospital care expires Sept. 15. A separate contract covering Aetna Medicare Advantage expires on Oct. 31, 2025, according to a HCA website page about the potential upheaval.

“Our goal is to reach a compromise with Aetna so you and your loved ones can continue to have the convenient access you expect at our 48 hospital campuses and other sites of care throughout Florida,” read the site.

Neither side in the dispute were willing to reveal how many patients could be affected but HCA is one of the state’s largest hospital chains. Its 48 hospitals include nine in the Tampa Bay region.

HCA Healthcare is continuing to negotiate an agreement with Aetna for commercial managed care and exchange products, according to a company statement provided to the Tampa Bay Times. “At this time, we are working with Aetna to reach a fair and equitable agreement so there is no disruption in services for patients,” read the statement.

Neither Aetna nor HCA would comment on when the two sides last negotiated . They also declined to comment further on any stumbling blocks. Officials from Aetna said they are still in the contract renewal process.

“We are hopeful that our contract discussions will result in an agreement that keeps HCA in our network in Florida,” said Aetna spokesperson Alex Kepnes.

Bargaining between insurance and medical care providers is normally conducted behind closed doors but it’s not unheard of for one side or both to go public with warnings of the disruption patients will face if no agreement is reached.

In 2022, BayCare Health System sent 215,000 letters to patients insured through Florida Blue warning that their services would be out of the insurer’s network and accusing the insurer of being unwilling to reach an agreement. Florida Blue responded by posting on its website that BayCare was asking for double-digit rate increases for diagnostic services like X-rays and MRIs and other medical imaging that would result in higher premiums.