Wakemed Patient Coverage at Risk with UnitedHealthcare Negotiations

Wakemed issued a warning on Wednesday about the potential loss of coverage for patients who rely on UnitedHealthcare for their insurance if the two parties can’t come to a contract agreement.

The healthcare provider had entered into a contract with UnitedHealthcare in 2022, which is set to expire on November 15th. If an agreement isn’t reached, Wakemed, along with various specialists in the Raleigh area, will no longer be part of the network for certain plans.

• Individual Commercial Plans sponsored by Employers
• Medicare Advantage Plans, including Group Retirement and Double Special Needs Plans

However, Wakemed has assured that primary care physicians employed by them won’t be impacted by these negotiations. Those signed up for UnitedHealthcare’s Medicaid plan will still be able to access Wakemed, regardless of the outcome of the talks.

According to Wakemed, discussions with UnitedHealthcare have stalled, claiming the insurance provider has been unwilling to agree to a fair contract. A spokesperson from Wakemed stated, “UnitedHealthcare believes it has the right to determine the need for individual healthcare. We do not agree.” They emphasized that insurance providers are not part of a patient’s care team.

The spokesperson added, “We believe that the patient’s medical needs should be determined by the patient and their physician, not by the insurance company. This really revolves around ensuring patients receive qualified benefits based on healthcare needs rather than the interests of the company.”

Wakemed alleges that UnitedHealthcare is refusing to reimburse them for patient care at a rate significantly higher than other insurers, and this has already delayed many processes.

Critics of health insurance companies argue that requiring pre-approval for crucial procedures can hinder patient care and, in severe cases, lead to dire consequences. In an incident involving former UnitedHealthcare CEO Brian Thompson, police referenced evidence that echoed phrases used to deny patient coverage.

WRAL News reached out to UnitedHealthcare, receiving a statement from Laurie Mandell, CEO of UnitedHealthcare at Carolinas Health Plan. She stated, “We are actively working on updating our network relationship with Wakemed to ensure our members continue to access care at competitive rates. Unfortunately, Wakemed hasn’t proposed a comprehensive solution, even with two months remaining in our current contract. We are dedicated to reaching an agreement and encourage Wakemed to engage in discussions.”

UnitedHealthcare also refuted Wakemed’s claims regarding refusal to reimburse, suggesting it was merely an attempt to shift focus from their negotiations.

This isn’t the first instance of a dispute between UnitedHealthcare and Wakemed. In 2022, their contract expired, and UnitedHealthcare patients lost coverage at Wakemed for half a year before a new three-year agreement was reached.

Additionally, in some states, employees may face higher health insurance costs due to a contractual dispute involving Duke’s health and insurance provider, Aetna, which is set to expire on October 20th.

UNC Health and Cigna are also engaged in contract negotiations, with their agreement expiring on November 30th.