WakeMed, UnitedHealthcare fail to reach an agreement, leaving thousands of patients out-of-network

UnitedHealthcare said this impacts about 20,000 patients, and WRAL has received several complaints from people who have either lost coverage or had trouble getting their medication.

Beginning Wednesday, UnitedHealthcare customers who use WakeMed hospitals, outpatient clinics and specialists are out-of-network.

This does not affect primary care doctors or emergency department visits.

A woman who lives in Youngsville who had surgery three weeks ago said she is unable to get a refill for the antibiotic she is taking every eight hours.

“If I don’t have in my hands what I need for Saturday, I will end up at about 7 a.m. in the ER at WakeMed asking for the dosage," she said.

Officials with UnitedHealthcare said WakeMed originally demanded a 20% price hike and the hospital has refused to negotiate.

In a statement, a UnitedHealthcare spokesperson said, “We’ve made numerous attempts to compromise and find solutions as part of good-faith negotiations. Unfortunately, WakeMed chose to cancel our contract, declined our offer to extend our current agreement, and never countered the multiple rate proposals we’ve provided since December.”

WakeMed, however, said they don’t want to talk rates until UnitedHealthcare addresses its reimbursement policies.

While UnitedHealthcare said it reimburses more than 90% of all claims, WakeMed said the company still denies claims at a rate of five to six times higher than other insurance companies.

"It’s really important to have these rules set so that we are actually getting reimbursed for the care we provide our patients, and around the decisions that are made between us and our patients," said Dr. Seth Brody, executive vice president and chief physician executive at WakeMed.

The North Carolina Department of Insurance also issued a statement on Thursday about the dispute between WakeMed and UnitedHealthcare.

“We understand that the contract stalemate between UnitedHealth and WakeMed could affect up to 20,000 WakeMed patients," the state wrote. "About 70% of those patients are covered by employer self-funded plans administered by United, with the remaining 30% covered under plans regulated by the N.C. Department of Insurance.

"Many of the WakeMed services obtained by these patients were emergency services, which will continue to be treated as in-network services as required under the No Surprise Act.”

Some patients in the middle of treatment, including pregnant women and cancer patients, may qualify for continuity of care. That will keep them covered despite UnitedHealthcare being out of network at WakeMed.