UnitedHealth’s remote patient monitoring decision shocks industry

Modern Healthcare – Friday, November 14, 2025
By Gabriel Perna

The future of remote patient monitoring just got murky.

Starting Jan. 1, UnitedHealth, part of UnitedHealth Group, only will cover the use of remote patient monitoring devices for its commercial and Medicare members who have heart failure or hypertensive disorders of pregnancy. The insurer said RPM for chronic obstructive pulmonary disease, diabetes and hypertension not related to pregnancy was not clinically proven and would not be covered.

The decision caught device companies and providers off guard as it was contrary to positive reimbursement trends from the Centers for Medicare and Medicaid Services. Stakeholders are wondering if other insurers will follow the lead of the nation’s largest insurer by covered lives and if so, what it means for reimbursement and patient care.

“United is one of the biggest two payers in the country. There will be hundreds of thousands, if not millions, of patients who will be affected by this,” said Lucienne Ide, CEO of Rimidi, a company that helps providers run RPM programs for patients with chronic diseases. “Diabetes and hypertension are the two of the most prevalent use cases for RPM.”

Remote patient monitoring companies criticized the decision, saying UnitedHealth cherry-picked data to justify a decision that was financially motivated. Instead, they say United was financially motivated to cut the coverage.

“This is a short-term financial decision, not a clinical one, and the policy’s own contradictions prove it,” said Daniel Tashnek, CEO of Prevounce, which helps providers run RPM programs for chronic disease patients. “They kept coverage for conditions like hypertensive disorders of pregnancy because managing that condition avoids an immediate, high-cost event like a premature birth and a long NICU stay. This provides a near-term cost saving.”

United’s decision may not be in compliance with CMS’ decision to expand reimbursement for remote patient monitoring, but pursuing a legal challenge would be difficult and timely, said T.J. Ferrante, partner and healthcare lawyer with law firm Foley & Lardner.

“The best-case scenario could be that CMS gets involved and starts issuing fines and penalties, because [United] is a contractor to the Medicare Advantage program,” Ferrante said. “The best bet is to get CMS to take a look at it and have them use their influence to change it.”

RPM companies and industry groups are trying to exert pressure by meeting with CMS in hopes the agency will step in for Medicare Advantage plans. They say CMS has endorsed RPM repeatedly through its physician payment rules.

UnitedHealth has said the decision is in compliance with CMS requirements. It also has cited two reports from the Health and Human Services Department’s Office of Inspector General that said additional safeguards should be put in place to ensure appropriate use of RPM for Medicare members.

Some monitoring companies said they expect providers to appeal the coverage denials, which in turn could have a negative impact on United’s Medicare Advantage Star Ratings.

At least one company is looking at other avenues of reimbursement for Medicare patients. Doctronic, which provides medical consultations to patients through telehealth and uses remote monitoring, will look to Medicare’s Advanced Primary Care Management program. The program doesn’t require as narrow of an approach as Medicare’s RPM billing codes but allows providers to be reimbursed for using the technology, said Dr. Adam Oskowitz, Doctronic’s co-founder.

“It’s essentially chronic care management and remote patient monitoring put into one specific use case and you can still bill through an APMC code but it’s modified in that you don’t need to track hours,” Oskowitz said. “You just need to show you have patient engagement.”

Pivoting to other programs isn’t a fullproof strategy. At Rimidi, some patients may qualify for chronic care management programs if they have two chronic diseases, not the one that has been needed for RPM programs, Ide said.

There have been some supporters of UnitedHealth’s move. Chris McGhee, CEO and co-founder hospital-at-home company Current Health, said in a LinkedIn post that the decision was “unsurprising and overdue.” Bad actors have built ventures that existed only to bill for remote patient monitoring, with no focus on outcomes and no benefit to consumers, he wrote.

Prevounce’s Tashnek said it will be up to companies to prove the programs work so insurers cover them.

“I think there’s some banding together in the industry for those of us who are doing this in good faith, that we have to go out and show our results at scale,” Tashnek said. “More data is the big thing.”

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