Under New Policy, UnitedHealthcare Can Retroactively Deny ED Claims
The American College of Emergency Physicians, which is suing Anthem over a similar policy, said they believe the policy is illegal but declined to comment on whether they would take legal action.
Modern Healthcare:
United Unveils Policy To Retroactively Deny Patient ED Claims
A controversial new UnitedHealthcare policy intended to tamp down on emergency department visits and costs has drawn ire from providers, while insurance analysts question what, if any, impact the regulation will have. Come July 1, the Minnetonka, Minn.-based insurer said it will take a more careful view of its 26.3 million commercial patients' emergency department visits, reviewing their initial reason for visiting the ED, the diagnostic and other services provided during the visit and the outcome of the experience, when deciding whether to approve—or deny—patient claims. UnitedHealthcare, the nation's largest health insurer, said it made the move to cut down on the $32 billion unnecessary ED use costs annually, driving up healthcare costs for all. (Tepper, 6/4)
WUSF 89.7:
Cyberattacks At UF Hospitals In Leesburg, The Villages Under Investigation
UF Health has confirmed that a cyberattack was detected at its hospitals in Leesburg and The Villages on May 31. Information technology teams are investigating at The Villages Regional Hospital and UF Health Leesburg Hospital after the hospitals' computer systems showed signs of unusual activity, an official said. (Byrnes, 6/5)
North Carolina Health News:
Cone Merger Cancelled, Future Consolidation Seems Inevitable
When they made the surprise announcement last week abandoning a merger that had been in the works for almost a year, Cone Health of Greensboro and Norfolk, Va.-based Sentara Healthcare said they had reached an amicable agreement that it was better for each hospital system to remain “independent.” Experts suggest that could be a posture that’s easier for the much larger Sentara to retain than for mid-sized Cone. (Wireback, 6/7)
Stat:
Carbon Health Dives Into Digital Diabetes Care, Acquires Steady Health
As health care providers large and small prepare for a transition from virtual to in-person care, one startup is carefully hedging its bets. As it builds toward its goal to open 1,500 clinics by 2025, primary care provider Carbon Health has acquired digital diabetes clinic Steady Health, marking the company’s first foray into virtual care for chronic conditions. (Brodwin, 6/4)
CNBC:
Amazon Health-Care Threat? Teladoc CEO Says It's ‘Overrated'
Ask a sports star before a game whether their team is going to win and they’re likely to say yes with confidence. And then cue the headlines that will sensationalize the hubris. But would you expect an athlete to say — would you want them to think — they’re about to lose? The heads of companies sometimes talk about the competition in a similar way, and they shouldn’t be in the CEO hot seat without confidence in their company’s ability to win. Take Teladoc Health CEO Jason Gorevic, recently asked at the CNBC Healthy Returns Summit about the threat Amazon poses in health care. (Rosenbaum, 6/6)
KHN:
Montana Med School Clash Revives For-Profit Vs. Nonprofit Flap
Two universities are eyeing the chance to be the first to build a medical school in one of the few states without one. The jockeying of the two schools — one a nonprofit, the other for-profit — to open campuses in Montana highlights the rapid spread of for-profit medical learning centers despite their once-blemished reputation. Montana is one of only four states without a medical school, making it fertile ground for one. (Knight, 6/7)
