WakeMed and UnitedHealthcare Negotiations Ongoing
WakeMed announced on Tuesday that if an agreement is not reached, UnitedHealthcare will stop covering Medicare Advantage plans starting Saturday, November 15.
Currently, both organizations are in negotiations, with their contracts set to expire on the same day.
Officials from UnitedHealthcare shared with WRAL News that they are aiming for a deal that remains affordable for both the public and employers.
In their statement, UnitedHealthcare noted, “WakeMed is requesting nearly 40% increases, including a 30% hike in the first year of the contract, which would make it the most expensive health system in the Raleigh area. This proposal could raise healthcare costs for North Carolinians and employers by over $94 million in two years.”
UnitedHealthcare claims they are offering “significant rate increases that would allow WakeMed to continue receiving reimbursement at competitive market rates.”
WakeMed officials, in a statement to WRAL News, said they are committed to negotiations with UnitedHealthcare, expressing the intent to stay in-network, although they’ve paused discussions specifically about the Medicare Advantage plan.
“On November 7, UHC informed WakeMed that it would no longer negotiate regarding its Medicare Advantage plans. Consequently, WakeMed’s hospitals, outpatient clinics, urgent care, and specialized practices are expected to cease being in-network for UnitedHealthcare’s Medicare Advantage plans after November 15, 2025,” they stated.
“We are approaching discussions in good faith, hoping that UHC will also engage and agree to terms that reflect our shared commitment to patients,” WakeMed officials mentioned.
They added that the terms proposed by UHC thus far are “unsatisfactory because they threaten WakeMed’s ability to fulfill its mission of caring for everyone. Given the increasing costs for supplies, equipment, and labor, a UHC proposal lacking adequate reimbursement adjustments for inflation over the next four years is not just unacceptable, but also unfeasible.”
Furthermore, WakeMed indicated that the fees received from UnitedHealthcare are “much lower” compared to those from other Triangle hospitals for similar services.
This disparity, they noted, places WakeMed at a competitive disadvantage regarding hiring nurses and physicians and limits their business development opportunities.
UnitedHealthcare, on the other hand, emphasized that if no agreement is reached by Saturday, WakeMed facilities and specialized care providers will fall out of network for not only Medicare Advantage plans but also for employer-sponsored and individual commercial plans.
