Health Insurers Shouldn’t Be Incentivized to Deny Patients’ Emergency Room Visits
The health insurer UnitedHealthcare recently sparked outrage by saying it may retroactively deny patients’ emergency room claims. But documents suggest the company has been denying such claims for years.
For-profit health insurance companies regularly refuse to pay for medical services because denials boost their profits, and they have little incentive not to deny coverage. (Catholic Church England and Wales / Flickr)
The man’s son had been vomiting, feeling nauseous, and experiencing bad heartburn for several weeks. The child’s pediatrician eventually made the call: It was time to take the boy to the ER.
The father, who requested anonymity, wasn’t the sort of person who went to the emergency room on a whim. He was an internal medicine physician after all, so he tried to avoid ER visits as much as possible. But in late 2019, he listened to the boy’s doctor and took his son to the ER near where they lived in Florida, then took him a second time when he once again couldn’t hold down food.
The decision ultimately seemed to make sense. Tests found the boy was suffering from a newly onset autoimmune disorder. But the family’s insurer, UnitedHealthcare, refused to pay the bills, which totaled $7,000 — $4,000 of which the hospital’s physician services company has since demanded from the family.
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