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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...........

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

Close to half of Medicare enrollees lacked dental coverage in 2019, new KFF data shows

Meanwhile, in 2021, 94% of Medicare Advantage enrollees in individual plans are in a plan that offers access to some dental coverage.

Close to half of all Medicare beneficiaries, totaling around 24 million people, did not have dental coverage in 2019, and the same percentage did not have a dental visit within the past year, according to a new analysis published by the Kaiser Family Foundation.

The numbers point to disparities around race and socioeconomic status, as those lacking dental insurance were seen in higher rates among Blacks (68%) or Hispanics (61%), those who had low incomes (73%), or those who were in fair or poor health (63%), as of 2018.

Average out-of-pocket spending on dental services among Medicare beneficiaries who had any dental service was $874 in 2018. One in five Medicare beneficiaries who used dental services spent more than $1,000 out-of-pocket on dental care.

Meanwhile, in 2021, 94% of Medicare Advantage enrollees in individual plans are in a plan that offers access to some dental coverage. Among these Medicare Advantage enrollees, 86% are offered both preventive and more extensive dental benefits.

More than three in four Medicare Advantage enrollees who are offered more extensive coverage are in plans with annual dollar limits on dental coverage, with an average limit of $1,300 in 2021; more than half (59%) of these enrollees are in a plan with a maximum dental benefit of $1,000 or less.

Nearly two-thirds of enrollees (64%) with access to preventive benefits, such as oral exams, cleanings and/or x-rays, pay no cost sharing for these services, though their coverage is typically subject to an annual dollar cap.

The most common coinsurance for more extensive dental services, such as fillings, extractions and root canals is 50%. Meanwhile, about 10% of Medicare Advantage beneficiaries are required to pay a separate premium to access any dental benefits.


Without dental coverage, many people on Medicare forgo needed and routine dental care – an issue that disproportionately impacts communities of color – with significantly fewer visits to the dentist in the past year among Black and Hispanic beneficiaries compared to white beneficiaries.

To read more............

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