Some healthcare providers choose only to accept payment directly from patients, leaving it to the patients themselves to seek reimbursement from their insurance companies for covered services.  This works better in some fields of medicine than others.  If you are a chiropractor or mental health counselor who tends to charge by the session, then one session does not amount to an astronomical cost; patients know, going in, how much you will expect them to pay, and they know whether they can afford it.  Emergency room visits, by nature, tend to be unpredictable and catastrophically expensive; even patients whose health insurance covers the visit itself struggle for years with the fees charged by the out-of-network physicians who treated them in the ER.  United Healthcare, one of the nation’s largest providers of health insurance, has announced a decision that, while making insurance coverage more affordable, may leave patients paying out of pocket for emergency room visits that can easily cost thousands of dollars.  If you are struggling to collect payment from patients whose insurance only covers some of the necessary services you provide to them, contact an Alabama creditors’ rights lawyer.

No Insurance Coverage for Non-Emergency Visits to the Emergency Room

United Healthcare (UHC) recently announced a change to its policy on insurance coverage for emergency room visits.  It currently charges members a flat fee for emergency room visits; if the physicians on duty in the ER at the time of the visit are not in-network, those physicians can still send a separate bill to the patients, at out-of-network prices.  Beginning on July 1, though, not all ER visits will be eligible for the flat fee.  In evaluating emergency room visit claims, United Healthcare’s claims adjusters will determine on a case-by-case basis whether the reason for the visit qualifies as an emergency.  It will deny claims for non-emergency visits to the ER.

In other words, if the patient went to an outpatient clinic and their doctor referred them to the ER, there is no question that the visit is an emergency.  The same goes for ER visits that result in the patient being admitted to the hospital.  United Healthcare may deny the claims, however, if the ER doctor simply instructs the patient to follow up with their doctor on Monday.  The best bet for patients who suffer worrisome but not life-threatening symptoms on weekends is to visit an outpatient urgent care clinic.

If you are a healthcare provider who accepts payment through UHC, you should inform your patients about this change in policy.  You should instruct them to call your after-hours line if they have complications before their next follow-up visit, and you can determine whether they should see you in the office the next day or go straight to the ER.  This way, the patient’s medical records will show that the patient visited the ER on your instructions and not merely because they felt ill.

Contact Us Today for Professional Help

A Birmingham creditors’ rights lawyer can help you structure your billing in ways that make it most feasible for you to collect payment, whether from insurance companies or from patients themselves.  Contact Cloud Willis & Ellis for a consultation on your case.