UnitedHealthcare’s plan to stick patients with ER bills has caught them in a PR nightmare. Here’s how they’ll get past it and make it your nightmare.
United’s plan? Refuse to pay your bill if one of their “denial nurses” decides you weren't sick or hurt enough for the ER.
Earlier this month, UnitedHealthcare, the nation’s biggest insurer, quietly posted a policy change that almost no average person would ever see or understand but that, beginning July 1, could have subjected millions of Americans to financial ruin (or worse) after a visit to an emergency room.
I have no doubt UnitedHealthcare thought the change would not attract much attention, but it did and became a significant PR crisis for the company. As someone who handled plenty of similar crises for big insurers, I can shed light on what has likely been going on at the company’s Minnetonka, Minnesota, headquarters over the past few weeks.
First some background. Every month, private insurers post dozens of obscurely worded policy changes on their websites that doctors and hospitals have to monitor closely because the changes can have a huge impact on how they treat their patients and get paid by insurers. One reason Americans spend so much more on health care than people in any other country is because hospitals and physician practices can’t afford not to have people on staff who do nothing, day in and day out, but try to keep track of every insurance company’s ever-changing policies and procedures.
Had United pressed ahead as planned, the company next week would have started refusing to cover some or all of a patient's E.R. bill if a United denial nurse decided the patient wasn’t sick enough or hurt enough to have gone to the E.R. in the first place. This retroactive review of E.R. claims could have resulted in millions of people enrolled in the company’s health plans having to pay thousands of dollars out of their own pockets for care they assumed would be covered. Or, even worse, been afraid to go to the E.R. because of the new policy and dropped dead.
The American College of Emergency Physicians (ACEP) learned about United’s policy change on Friday, June 4 when some of its members and a Modern Healthcare reporter called about it. Later that day, the publication carried a story under the headline, “United unveils policy to retroactively deny patient ED claims.” As the story indicated, ACEP, which a few years ago sued Anthem, another big insurer, for trying to pull off the same policy change, began raising the alarm and pushing back right away.
The Modern Healthcare reporter also, of course, reached out to United for comment, a query that would have immediately put the company’s PR team in damage-control mode. Someone on that team had to put together a statement to email Modern Healthcare, but, you can be certain, not before sending it to a few folks higher up the food chain, including the company’s army of lawyers, for review.
This is what that ad hoc group of corporate bureaucrats came up with: “We are taking steps to make care more affordable, encouraging people who do not have a healthcare emergency to seek treatment in a more appropriate setting, such as an urgent care center. If one of our members does receive care in an emergency room for a non-emergent issue, like pink eye, we will reimburse the emergency facility according to the member’s benefit plan.”
I used to write statements like that for a living. It’s soul-sucking work but it pays well. So I know the drill. I also know that PR people can avoid having conversations with reporters by simply emailing a carefully worded, lawyer-approved statement. Replying only by email eliminates the risk of having to answer tough questions on the fly and see a comment attributed to you that the CEO might not like. If you want to have a successful career in the PR business, you learn early not to take that risk.
Four days after the Modern Healthcare story appeared, MedPage Today published a story that shows United’s executives were beginning to feel some heat. The story noted that concern over the company’s new rule “has been making the rounds in the emergency physician community.”
It’s clear from the story that United’s designated spokesperson emailed MedPage the same statement they’d sent Modern Healthcare, although the MedPage story had this additional sentence up front: “Unnecessary use of the emergency room costs nearly $32 billion annually, driving up health care costs for everyone.”
It’s troubling that MedPage and other media used that sentence because that $32 billion number is one that United itself came up with. Back in 2019, United did a “study” of its E.R. claims, figured out the average cost of each visit, and did some extrapolating. Even Kaiser Health News published it without questioning the source or the source’s motives. Surprise, surprise: According to KHN, United concluded that “as many as two-thirds of the nation’s 27 million annual emergency room visits could be avoided.” That’s wildly at odds with research from a much more trustworthy source, the Centers for Disease Control and Prevention, which estimates that 3.1% of emergency room visits are non-urgent.
Now that we’ve witnessed United’s botched rollout of its new policy, it’s obvious, at least to me, that the company did that study to set the stage for the policy change, which, I’m sure, would have been implemented last year had the pandemic not forced a postponement.
Note to reporters: Use “studies” like that from insurers and outfits like America’s Health Insurance Plans at your own peril. Take it from me: They NEVER do studies that aren’t supportive of some current or planned business practice or propaganda campaign. If the results don’t show what they want, the study will be buried. You’ll never know about it. And when you do get a news release about a study they’ve done or funded, demand to see the methodology. And know that, just as insurers have a long history of cherry picking customers, they have an equally long history of cherry picking data for their “studies.”
Back to United’s current PR mess. It’s one thing to get calls from reporters with trade publications only a few people like me ever see. It’s something else entirely when The New York Times and USA Today call, which is what happened next. I’d bet good money that those calls triggered a code blue, oh shit, situation in Minnetonka. The PR team would now have to brace the company’s bigwigs, including Sir Andrew Witty, the new CEO, for headlines they were going to hate and that members of Congress, shareholders and other important folks would soon see. They likely would have said to Sir Witty, “Look, we’re in damage control here. We can make this story go away if you’ll let us tell the media we’re reconsidering the policy and will at least delay it.”
And that’s what happened. The headlines over the stories in both the Times and USA Today noted that United was backing down--for now. At least until the pandemic is over, which, presumably, will be over when Sir Witty says it’s over.
Both the Times and USA Today stories included this new statement (emailed, of course): “Based on feedback from our provider partners and discussions with medical societies, we have decided to delay the implementation of our emergency department policy until at least the end of the national public health emergency period.”
This reminds me of a similar crisis several years ago that my team and I had to handle when Cigna decided it would only cover a two-day stay in the hospital for women who had just had a baby or undergone a mastectomy. The outcry from doctors was fast and furious, and Cigna, like United, backed down. The bad press, which started in the Hartford Courant and spread like wildfire, led to Congressional hearings and new laws to put those length-of-stay decisions back in the hands of doctors (for the most part, anyway).
ACEP believes United’s proposed policy violates federal law, which, as USA Today noted, requires insurers to cover E.R. care “based on the presenting symptoms that brought the patient to the emergency room and not the final diagnosis.” As Dr. Mark Rosenberg, the organization’s president was quoted as saying, “UnitedHealthcare is expecting patients to self-diagnose a potential medical emergency before seeing a physician, and then punishing them financially if they are incorrect.”
ACEP last week took the lead in drafting a letter to United calling for a “full and permanent rescission of the policy” to “ensure the safety of our patients and your enrollees.” It was signed by a long list of provider and patient advocacy groups, including the American Medical Association and the nonprofit I lead, the Center for Health and Democracy.
As of today, United has not responded to the letter. I will be shocked if the company rescinds that policy “fully and permanently.” What it will do is implement the change when the heat is off ,as this new statement on its website implies: “We will use this time to continue to educate consumers, customers and providers on the new program and help ensure that people visit an appropriate site of service for non-emergency care.”
Bottom line: When United does implement the new policy, it will avoid paying for care that people thought were true emergencies.
An untold number of people will just not go to the E.R., and some of them will die.
But United, which last year made $22.4 billion in profits and is now the 7th largest company in America, will make even more money for Sir Witty and the company’s other already rich shareholders.
Your point about hiding data should be a big deal. Pharma does it, too.
A potential ally at the Arnold Foundation, Laura Arnold: https://youtu.be/Y2y7BzjbSNo
Chris