By Adam Lidgett

Law360 (October 27, 2020, 7:00 PM EDT) -- Health insurers have been hoarding premium dollars during the COVID-19 pandemic and some have have refused to cover emergency care if they "unilaterally" find it isn't warranted, the American Hospital Association says.

In a letter Friday to top House Democrats — including Energy and Commerce Committee Chairman Frank Pallone Jr. of New Jersey — the AHA said that "many health insurers are not spending nearly as much on care as they anticipated when they set their 2020 premiums."

The hospital trade group said insurers like Anthem are "denying coverage of emergency services if the health insurer unilaterally determines that the condition did not warrant emergency-level care."

Additionally, AHA targeted UnitedHealthcare, saying the insurer decided to stop paying back providers who have treated certain inpatient sepsis cases.

On top of that, AHA said that UnitedHealthcare "has launched new reporting requirements on many of its network laboratories during the pandemic, including certain hospital-based laboratories that are already stressed by the significant demand for COVID-19 testing."

"These new requirements are questionable in value, in violation of [Health Insurance Portability and Accountability Act] transaction standards, and extremely burdensome for hospitals," the letter said. "Specifically, the insurer is requiring as a condition of payment that these laboratories report their unique, organization-specific lab codes, as well as a number of other data points that may or may not exist, such as identifying a lab director for each test and including lab test availability dates."

Insurers in certain instances have been using money meant to cover the costs of health care to jack up their own profit margins, the letter said.

While "most insurers have waived cost-sharing for COVID-19 care," the letter said. "even this promise has not been fully met." Even though COVID-19 tests remain critically important, insurers have been refusing to pay for tests they don't think are a medical necessity, the letter said.

"Some hospitals have reported losing in the hundreds of thousands to millions of dollars as a result of denied testing claims," AHA said.

While AHA's letter criticized insurers, it also offered potential fixes.

The association said that the Energy and Commerce Committee could make insurers immediately process outstanding payment claims and bar "emergency care denials based on retrospective review."

AHA said that hospitals and health systems in the U.S. are expected to lose "$323.1 billion in 2020" as a result of the pandemic.

In August, the House committee announced it was looking into the practices of various insurers during the COVID-19 pandemic, noting at the time that the panel was worried that certain plans were not in compliance with consumer protection measures.

In a statement to Law360 on Tuesday, UnitedHealthcare said, "UnitedHealthcare has taken numerous steps to combat the COVID-19 pandemic by supporting frontline workers, members, partners and the health care system. Earlier this year, we waived cost-sharing for COVID-19 testing and treatment, provided members $1.5 billion in premium and other relief, accelerated $2 billion in payments to providers, and invested more than $100 million in community-based philanthropic efforts."

Representatives for Anthem and Democrats on the Energy and Commerce Committee did not immediately respond to requests for comment.

The AHA declined to comment beyond the letter.

--Editing by Jill Coffey.

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