WakeMed fails to reach an agreement with United Healthcare, leaving thousands of patients out of network

2 June 2022

— After months of negotiations, WakeMed failed to reach an agreement with UnitedHealthcare on Wednesday night.

UnitedHealthcare said this impacts about 20,000 patients — and we’re already hearing from some people who are having trouble getting the medication they need.

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.

Officials with WakeMed said United 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. Sam Brody, executive medial director of WakeMed Cary Hospital.

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.

This post was originally published on this site

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