Updated September 6, 2024
Our top priority is to reach an agreement with Duke Health that provides continued, uninterrupted access to the health system while helping ensure North Carolinians and employers have access to affordable care
We are committed to good-faith negotiation and utilizing the remaining time on our contract to engage in productive discussions with Duke Health in an effort to renew our relationship. We hope the health system shares our commitment toward reaching an agreement that’s affordable for North Carolina families and employers.
If we are unable to reach an agreement, Duke Health’s hospitals, facilities its physicians will be out of network for the following plans, effective Nov. 1, 2024:
- Employer-sponsored commercial plans, including UMR
- Medicare Advantage plans, including Group Retiree and our Dual Special Needs Plan (DSNP)
While Duke Health does not currently participate in our Medicaid network, it’s important to note people enrolled in our Medicaid plan can continue to receive care at Duke Health as they do today. We will reimburse the health system for the services provided.
In the event we do not reach an agreement, people enrolled in our Group Retiree Medicare Advantage PPO plans and our Dual Special Needs Plan (DSNP) PPO plan may still receive care from a Duke Health hospital or physician as an out-of-network provider, if they are a Medicare-approved provider that accepts the plan. Their share of the cost will be the same as if they were part of the network for some or all services.
UnitedHealthcare Group Retiree Medicare Advantage and DSNP PPO members are encouraged to speak with their physician to confirm they’ll continue to see them, regardless of their network status.
For additional information about our Group Retiree plan as well as information on how to find a provider in their area, UnitedHealthcare members should go to retiree.uhc.com.
For additional information on our DSNP PPO plans, you can go to: https://www.uhc.com/communityplan/north-carolina/plans/medicare/2024/dual-complete-choice-ppo-snp
We recognize this is difficult and you may have questions. We have created the following FAQs to ensure you and your family have the information needed regarding next steps as well as details to help meet your health care needs.
FAQs
If we are unable to reach an agreement, Duke Health’s hospitals, facilities and its physicians will be out of network for employer-sponsored commercial plans, including UMR, as well as our Medicare Advantage plans, including Group Retiree and our Dual Special Needs Plan (DSNP), effective Nov. 1, 2024.
This negotiation impacts people enrolled in employer-sponsored commercial plans, including UMR, as well as our Medicare Advantage plans, including Group Retiree and our Dual Special Needs Plan (DSNP).
Yes. Our goal is to reach an agreement that avoids any disruption to our members. We are committed to continued good-faith negotiation and utilizing the time remaining on our contract to engage in productive discussions with Duke Health in an effort to reach a long-term agreement. We hope Duke Health shares our commitment toward reaching an agreement that’s affordable for North Carolinians and employers.
While Duke Health does not currently participate in our Medicaid network, it’s important to note people enrolled in our Medicaid plan can continue to receive care at Duke as they do today. We will reimburse Duke for the services provided.
In the event of an emergency, UnitedHealthcare members should go to the nearest hospital. Emergency care will be covered at the in-network benefit level, regardless of whether the hospital participates in our network.
In the event we do not reach an agreement, people enrolled in our Group Retiree Medicare Advantage PPO plans and our DSNP PPO plan may still receive care from a Duke Health hospital or physician as an out-of-network provider, if they are a Medicare-approved provider that accepts the plan. Your share of the cost will be the same as if they were part of the network for some or all services.
UnitedHealthcare Group Retiree Medicare Advantage and DSNP PPO members are encouraged to speak with their physician to confirm they’ll continue to see them, regardless of their network status.
For additional information about our Group Retiree plan as well as information on how to find a provider in their area, UnitedHealthcare members should go to retiree.uhc.com.
For additional information on our DSNP PPO plans, you can go to: https://www.uhc.com/communityplan/north-carolina/plans/medicare/2024/dual-complete-choice-ppo-snp.
You and your family will continue to have access to thousands of physicians and several hospitals throughout the Raleigh and Durham areas, should Duke Health leave our network. Hospitals remaining in our network include but are not limited to:
- Alamance Regional Medical Center
- Granville Medical Center
- Johnston Health*
- Johnston Medical Center-Clayton
- Person County Memorial Hospital
- Rex Hospital
- University of North Carolina Hospitals
- WakeMed Cary Hospital
- WakeMed North Hospital
- WakeMed Raleigh Campus
*Does not participate in our Medicare Advantage network.
If you need assistance finding an alternative provider in your area, please call the number on your health plan ID card. You can also use the provider directory on our member website to search for alternative hospitals and doctors.
If you or someone in your family is in the middle of treatment with a Duke Health provider at the time they go out of network, you may qualify for continuity of care. Continuity of care provides continued in-network benefits for a specified period of time after a provider leaves our network. A few examples of patients who may qualify include but are not limited to:
- Women who are pregnant;
- Patients with newly diagnosed or relapsed cancer, or those currently in active cancer treatment.
Members who have questions about continuity of care and whether they may be eligible should call the number on their health plan ID card.
UnitedHealthcare members should always go to the nearest hospital in the event of an emergency. Their services will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.