Updated October 17, 2022
Duke Health has left our UnitedHealthcare Community Plan network
Duke Health’s hospitals, facilities and its physicians are now out of network for UnitedHealthcare Community Plan, as of Oct. 15, 2022 .
We made every effort to compromise and find a middle ground, including proposing to the health system that we extend our current contract to allow us additional time to negotiate without any disruption to you, your family and all North Carolina residents. Unfortunately, Duke refused.
We know the relationship you and your family have with your doctor is not only important; it’s personal. Please know our top priority is to restore network access to Duke and we are committed to meeting with the system as often as it takes to reach a new agreement. We urge Duke to join us at the negotiating table and to work with us to reach an agreement on behalf of the thousands of North Carolinians we collectively serve.
It’s important to note that you continue to have access to Duke’s facilities and its physicians for all services despite the system leaving our network as long as Duke agrees to see you. We will reimburse Duke as an out-of-network provider for any services they provide. We encourage you to speak to your physician to confirm they’ll continue to provide care for you and your family even after leaving our network. Please be assured that we will continue to cover your benefits and care provided at Duke, regardless of their contract status. You are only responsible to pay applicable co-payments under the Medicaid program.
In the event of an emergency, you should always go to the nearest hospital. Your services will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.
Please note that this negotiation does not impact our employer-sponsored, individual and Medicare Advantage plans, including our Dual Special Needs Plan, which continue to remain in-network with Duke.
As we continue our negotiation with Duke, we have created the following frequently asked questions to ensure you have the information you need.
Duke Health chose to leave our UnitedHealthcare Community Plan network. As a result, Duke’s hospitals, facilities and its physicians no longer participate in our UnitedHealthcare Community Plan network, as of Oct. 15, 2022.
This negotiation only impacts UnitedHealthcare Community Plan.
UnitedHealthcare employer-sponsored, individual and Medicare Advantage plans, including our Dual Special Needs Plan, continue to remain in-network with Duke and are not impacted.
We have been in discussions with Duke to renew our Medicaid relationship for nearly a year. We delivered a proposal to the health system in November 2021. Given that we never received a counter-proposal from Duke, we delivered an updated proposal in March 2022 that would reward Duke with financial incentives for providing quality care and improving health outcomes for the North Carolinians we collectively serve.
Duke informed us in June that it would be responding to our proposal, only to find out just days later from a competing health system that Duke had communicated its intentions to leave our Medicaid network. We were surprised to learn of Duke’s decision given it had not once voiced any concerns regarding the renewal of our relationship.
Since learning of Duke’s intentions to leave our network, we delivered another proposal that included numerous compromises as part of good-faith negotiations. We also proposed to Duke that we extend our current contract to allow us additional time to negotiate without any disruption to you, your family and all of the North Carolinians we’re honored to serve. Unfortunately, Duke refused.
You continue to have access to Duke’s facilities and its physicians for all services even after they leave our network as long as Duke agrees to see you. We would reimburse Duke as an out-of-network provider for any services they provide. We encourage you to speak to your physician to confirm if they’ll continue to provide care for you even after leaving our network.
Should Duke not provide care to you in a non-emergent situation, please call member services at 800-349-1855. The phone number can also be found on your health plan ID card. We will assist you in finding a new physician or health care facility that meets your needs. You may also go to UHCCommunityPlan.com to find physicians or facilities in your area that participate in our network.
We want you to know you continue to have access to a large network of hospitals, physicians and specialists that are readily able to provide high-quality care that meets your health care needs.
More than 90% of North Carolina’s hospitals continue to participate in our Medicaid network. Some of the hospitals remaining in-network in the Raleigh and Durham areas include, but are not limited to:
- University of North Carolina Hospital
- UNC Johnston
- UNC Rex Hospital
- Parson County Memorial Hospital
- Granville Medical Center
- Alamance Regional Medical Center
Our UnitedHealthcare Community Plan network in North Carolina consists of more than 37,000 primary care physicians and specialists. We have confirmed that more than 1,200 physicians in the Raleigh and Durham area alone are currently accepting new patients and are readily able to provide care for you.
We are also working on direct agreements with several physician groups that are affiliated with the Duke integrated network. These direct contracts will ensure continued network access to these providers. To date, we have reached a direct agreement with the following provider groups affiliated with Duke:
- Beckford Avenue Medical Center
- Hope Regional Medical Center
- North State Medical Center
- Roxboro Internal Medicine and Pediatrics
If you are in the middle of treatment at a Duke hospital, facility or with a Duke physician, you may qualify for continuity of care. Continuity of care provides continued in-network benefits for a specified period of time after a hospital or physician leaves our network. A few examples of patients who may qualify include:
- Women who are pregnant and undergoing a course of treatment for the pregnancy from the provider or facility.
- Patients with newly diagnosed or relapsed cancer, or those currently in active cancer treatment.
If you or someone in your family has questions about continuity of care, please call member services at 800-349-1855. The number can also be found on your member ID card.
You should always go to the nearest hospital in the event of an emergency. Your services will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.
We value you and appreciate the opportunity to serve you and your family. We want you to know that as a UnitedHealthcare Community Plan member in North Carolina you have access to extra benefits that include but are not limited to:
- A smartphone with free monthly unlimited data, minutes and texts.
- $75 towards a three-month youth membership or sports program offered at the YMCA for kids ages 6-19.
- 24/7 access to virtual doctor visits through the UHC Doctor Chat app or UHCDoctorChat.com.
- Up to $75 yearly in rewards for completing certain health, wellness and engagement activities.