UnitedHealth Moves to Restrict Out-of-Network Coverage

On the heels of walking back a hotly debated policy restricting emergency room coverage, UnitedHealthcare is now rolling out a different policy aimed at lowering health care costs by clamping down on some members’ out-of-network benefits. However, one industry observer predicts the latest policy change won’t see nearly as much blowback as UnitedHealth’s ER move.

In an email to AIS Health, a spokesperson for UnitedHealthcare stated that the insurer is updating its commercial certificate of coverage around out-of-service-area/out-of-network coverage of medical and behavioral health services — a change it will roll out through 2021 and 2022.

Policy Applies to ‘Subacute’ Services

The changes will apply to nonemergent, subacute inpatient and outpatient services at non-hospital facilities, based on where members live, the spokesperson said, adding that such facilities include residential treatment facilities, inpatient rehabilitation facilities and other nonhospital facilities. UnitedHealth will define a “service area” as the state where the member is currently a legal resident, plus any geographically bordering state.

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Leslie Small

Leslie Small

Leslie has been reporting and editing in various journalism roles for nearly a decade. Most recently, she was the senior editor of FierceHealthPayer, an e-newsletter covering the health insurance industry. A graduate of Penn State University, she previously served in editing roles at newspapers in Pennsylvania, Virginia and Colorado.

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