United says it needs timely notice to determine whether an admission is medically justified. But hospitals say they are in a better position to determine medical necessity of an admission and they see the new policy as a way to reduce reimbursements.
Five-hospital Continuum Health Partners, which includes Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center in New York, is refusing to sign a new contract with UnitedHealthcare over the issue.
Negotiations have become tense, with UnitedHealthcare warning tens of thousands of patients that coverage at Continuum hospitals and affiliated doctors may be cut off.
Greater New York Hospital Association has told the state attorney general that the 50 percent penalty would be “confiscatory.”
The state of Tennessee has exempted hospitals from UnitedHealthcare’s penalty on weekends or federal holidays, when hospitals have fewer staff to process admissions.
The Florida Hospital Association has asked Florida’s insurance regulators to monitor the situation.
Wellpoint and a few other insurers contacted by the Times say they do not have such a policy.
Read the New York Times’ report on UnitedHealthcare’s policy.
