The New York Insurance Department (NYID) has issued a request to
health insurer UnitedHealthcare (United) to delay implementation of
what New York State Superintendent of Insurance Eric R Dinallo
termed a “controversial” new policy requiring hospitals to provide
notice within 24 hours after a patient has been admitted.
According to the request issued on 30 November 2007, United will
impose a penalty of up to 50 percent of normal payment if a
hospital fails to notify United within 24 hours after a patient’s
admission. There are no exceptions to this policy, even for
weekends or holidays. “We are concerned that United’s 24-hour
notice requirement may be in violation of laws protecting consumer
access to emergency services,” said Dinallo.
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Defending its notification policy, United said in a statement
issued on 20 December that its new policy had “stimulated a
productive dialogue” between it and healthcare facilities. Concerns
raised included “the potential administrative challenges that
weekend and holiday notifications may place on some facilities”,
said United.
As a result, United said, it had modified the implementation of its
new policy. As a first step, the insurer said it would work with
about 200 facilities on a pilot programme that will test the
process to identify and address any operational issues associated
with facilities transmitting daily notifications. Secondly, until
the pilot is completed and results assessed, United will delay
implementation of the 24-hour notification provision for admissions
on weekends and holidays until 30 June 2008. Such admissions will
require notification by the next business day.
United added that more than 1,000 hospitals have agreed to work
toward electronic notification seven days a week. “We applaud their
leadership and believe their commitment confirms our mutual goal of
making health care simpler, less costly and, most important, better
for patients,” said United.
However, in its statement the NYID had noted: “Hospitals have
complained that the notification policy is simply another hurdle
that increases administrative burdens on providers and allows the
health plan to deny payment on technical grounds without any
demonstration that the notification will be effectively used to
coordinate care.”
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