UnitedHealthcare Halts Remote Patient Monitoring Coverage for Diabetes and Hypertension
- 4 days ago
- 2 min read
The healthcare industry has been met with surprise and concern following UnitedHealthcare’s (UHC) recent decision to drastically narrow its coverage for Remote Patient Monitoring (RPM) services under its Medicare Advantage (MA) plans. This policy change, which goes into effect on January 1, 2026, rolls back reimbursement for RPM for many common chronic conditions, including diabetes mellitus, chronic obstructive pulmonary disease (COPD), mental health conditions, and general hypertension.
Under the new restrictions, covered remote physiologic monitoring services will be almost entirely limited to just two diagnoses: chronic heart failure and hypertensive disorders during pregnancy. A UnitedHealthcare spokesperson explained that this policy is "based on the latest clinical evidence". The insurer’s policy document explicitly states that remote physiologic monitoring for the excluded conditions is “unproven and not medically necessary due to insufficient evidence of efficacy”. This decision has shocked the industry, impacting startups and the broader healthcare system that relies on RPM technology.
This restriction stands in sharp contrast to the broader direction of the U.S. healthcare system. The Centers for Medicare & Medicaid Services (CMS) has historically shown growing support for RPM since its introduction in 2019, continually expanding coverage to encourage preventive care and chronic disease management. This CMS stance is supported by multiple clinical studies demonstrating RPM’s value, including evidence of reduced hospital admissions and significant cost savings. For example, one analysis of 5,872 patients found annual savings of $1,308 per patient in programs covering heart failure, hypertension, and diabetes, due primarily to a 27% reduction in hospital admissions.
UHC’s rationale—citing insufficient evidence—has drawn substantial criticism. Legal and health policy experts have raised serious concerns that this move could establish a potentially restrictive precedent for other Medicare Advantage benefits. Emily Cook, a lawyer specializing in MA regulations, argued that MA plans are explicitly required by statute to cover all benefits available through traditional Medicare. She contended that UHC’s selective interpretation of the ability to make coverage determinations when no national or local coverage rules exist is "not an appropriate characterization of the statute".
Furthermore, the change could be highly detrimental to patients. TJ Ferrante, a partner at Foley & Lardner, noted that the change could harm potentially “tens of thousands of patients” who receive remote monitoring because their doctors deem it appropriate and have ordered it. Providers who have invested in RPM infrastructure must now immediately audit their UnitedHealthcare Medicare Advantage patient populations for non-covered conditions (like Type 2 diabetes or general hypertension) and develop clear transition plans using alternatives such as in-person check-ins.
While industry stakeholders have alerted CMS about UHC’s policy, the agency has not yet responded publicly. If the policy is challenged and found to violate coverage requirements, CMS has the authority to enforce penalties against UnitedHealth Group. This restrictive shift reopens the national debate on the vital role of Remote Patient Monitoring in managing chronic conditions, creating operational hurdles for clinics and considerable uncertainty for millions of seniors.
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Keywords: Remote Patient Monitoring
Remote Patient Monitoring
