Hospital Services: Observation and Inpatient – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers observation-level care for a defined list of acute conditions (e.g., chest pain, pneumonia, dehydration, seizures) when medical necessity and level-of-care meet InterQual criteria, but observation is not covered for convenience, while awaiting placement, and the observation rules do not apply to obstetric members during pregnancy/childbirth/postpartum. Key requirements: expected improvement within 48 hours or submission of additional clinical information to justify inpatient conversion, with documentation of history, exam, diagnostics, treatments/response and review of member-specific benefits and applicable mandates.

"Observation level of care for management of diabetes mellitus"

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