WakeMed is warning patients on Wednesday that those with UnitedHealthcare as their insurance provider could lose coverage at the hospital if the two sides do not reach a contract agreement.
The health care provider signed a contract with the insurance provider to cover patients under UnitedHealthcare in 2022. The contract is set to expire on November 15. If the two sides cannot reach an agreement, WakeMed’s facilities and specialty providers in the Raleigh area will be out of network for people enrolled in the following plans:
- Employer-sponsored and individual commercial plans
- Medicare Advantage plans, including Group Retiree and Dual Special Needs Plan
The insurance provider said primary care physicians employed by WakeMed are not impacted by the negotiations and will stay in-network, and people enrolled in UnitedHealthcare’s Medicaid plans will continue to have access to WakeMed, regardless of the outcome of its negotiations with WakeMed.
According to WakeMed, negotiations with UnitedHealthcare have stalled because the insurance provider is “unwilling to agree to a new, reasonable contract” with the hospital.
“UnitedHealthcare believes they have the right to determine the necessity of an individual’s medical care. We disagree,” a WakeMed spokesperson said in a statement provided to WRAL News, adding that the insurance provider is not a part of a patient’s care team.
“We believe a patient’s need for medical care should be determined by the patient and their doctor, not their insurance company,” the spokesperson said. “Ultimately, this is about making sure our patients get the benefits they are entitled to and that their care decisions are based on medical need—not corporate profit.”
According to WakeMed, UnitedHealthcare is denying reimbursement for care to WakeMed patients at rates almost three times higher than any other insurance provider, and often after a procedure has already been performed.
Many critics of health insurance companies have said preauthorization for important procedures end up delaying care for patients and can sometimes result in their death. In the assassination of Brian Thompson, UnitedHealthcare’s former CEO, police said shell casings for bullets used by his accused assassin, Luigi Mangione, had the phrase “deny, delay, depose,” inscribed on them, mimicking a phrase used to prevent coverage for patients.
WRAL News reached out to UnitedHealthcare, which provided the following statement from Laurie Mandell, UnitedHealthcare CEO of the Carolinas Health Plan:
“We are working to renew our network relationship with WakeMed so our members can continue accessing care at affordable, market-competitive rates. Unfortunately, WakeMed has not yet provided a single comprehensive proposal, even with less than two months left on our current agreement. Instead, they’ve stalled discussions and are repeating a pattern of putting North Carolinians in the middle of negotiations while spreading misinformation, as they’ve done with multiple insurers in recent years. We remain committed to reaching an agreement and are asking WakeMed to join us at the table to move this forward.”Laurie Mandel
UnitedHealthcare also denied the accusations made by WakeMed of denying reimbursement, adding that it was “nothing more than an attempt to distract from our negotiations.”
This is not the first time UnitedHealthcare and WakeMed have been locked in a fight over coverage. The contract between the two sides expired in 2022, and UnitedHealthcare patients lost coverage at WakeMed for six months until the two sides agreed to a new three-year contract.
It also comes as some state employees could pay more for their health insurance, as Duke Health and insurance provider Aetna are involved in a contract dispute. Duke and Aetna’s contract expires on Oct. 20
UNC Health and Cigna are also locked in a contract dispute. That agreement is set to expire on Nov. 30.
Source: WakeMed joins list of Triangle health groups fighting for new contract with insurance
