Updated August 12, 2022

WakeMed has disrupted North Carolinians’ access to care

Although we negotiated in good faith for several months, we were not able to reach an agreement with WakeMed. As a result, WakeMed’s hospitals, employed physicians and specialists – excluding WakeMed primary care physicians and ambulatory surgical centers – are now out of network for UnitedHealthcare employer-sponsored, individual and Medicare Advantage plans, as of June 1.

Our goal was to reach an agreement that avoided any disruption to our members and customers while holding true to our collective goal of making health care affordable for the people and employers of Raleigh and the surrounding communities. Unfortunately, WakeMed displayed little interest toward renewing our relationship. The health system canceled our contract, declined our offer to extend our current agreement, and never countered the multiple rate proposals we’ve provided since December. Based on WakeMed’s actions over the past several months, we can only assume it was always the health system’s intent to disrupt access to care for North Carolinians.

We will stay at the negotiating table as long as it takes to reach an agreement that restores network access to WakeMed. We urge WakeMed to join us there and work toward a solution that is in everyone’s best interests.

However, our primary focus at this time is ensuring that our members have uninterrupted access to the care they need and supporting them as they transition to new care providers. We know that network changes can be difficult, but our members can rest assured that they will continue to have access to high-quality, affordable care close to where they live and work. For additional information regarding continuity of care, as well as other hospitals remaining in our network throughout the Raleigh area, please click here.

WakeMed’s denied claims were due to the health system’s own administrative errors

WakeMed stated that UnitedHealthcare denies more claims than any other insurer they work with. While WakeMed has refused our request to provide examples of this occurring, we take these allegations seriously and looked into it. After reviewing our data, we found that the majority of the denials were due to an administrative error on the health system’s end.

Approximately 90% of WakeMed’s claims submitted to us over the past 12 months were approved. Out of the 10% that were denied, three out of every four claims were not accepted due to an administrative error by WakeMed. For example, approximately 25% of the claims that were denied were due to WakeMed submitting a duplicative claim. In other words, WakeMed errantly double-billed our members.

The vast majority of WakeMed’s claim denials were preventable and would have otherwise been approved if not for an issue in WakeMed’s internal processes. We continue to offer to assist and collaborate with WakeMed in helping them improve its administrative processes, which would reduce these unnecessary claim denials.

WakeMed is seeking a 20% price hike in just the first year of our contract

WakeMed issued a notice in November 2021 to cancel our current contract upon its conclusion and has maintained its demands for a 20% price hike for its hospitals in the first year of our contract as a condition of continuing our relationship. Agreeing to WakeMed’s proposal would increase health care costs by $20 million in just one year and is not affordable or sustainable for the North Carolina residents and employers we serve.

Agreeing to WakeMed’s demands would drive up premiums and out-of-pocket costs for our members as well as the cost of doing business for both self-insured and fully insured companies. These high rates have been a challenge for our customers for years, but as businesses throughout Raleigh and the surrounding areas struggle to keep their doors open and to pay competitive wages to attract and retain employees, it’s more critical now than ever that we ensure they can continue to offer their employees affordable health care benefits.

WakeMed’s demands would directly drive up health care costs for our self-insured customers given that these employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims. In the greater Raleigh area, more than 70% of our commercial members are enrolled in self-insured plans.

Agreeing to WakeMed’s 20% price hike demands would mean that some of our self-funded customers would see their health care costs increase between $243,000 to as high as $821,000 in just one year, meaning these employers have less money available to help grow the business through things like investments in new technologies or salary increases for hard-working employees.

WakeMed has been unwilling to negotiate and refused our proposal to extend our contract

WakeMed has only provided one formal proposal throughout the six-plus months of our negotiation.

We provided WakeMed a comprehensive rate proposal on Dec. 29, 2021, that provided the health system with fair and market-competitive rate increases. WakeMed never responded with a counterproposal regarding its reimbursement. In order to progress the negotiation forward, we countered ourselves by providing WakeMed a second rate proposal on March 15 that was a significant increase to our previous proposal. WakeMed has never responded to it.

Due to WakeMed’s refusal to negotiate in a timely manner, we proposed that we extend our current contract while we continue to work toward a solution on a new relationship. WakeMed refused, intentionally putting approximately 20,000 North Carolinians in the middle of our negotiation.

WakeMed is also seeking special exceptions to standard language in its contract that help protect our members from unnecessary costs and protect access to care

WakeMed is demanding language in its contract that limits consumer freedom and choice regarding where care takes place and who provides it. Specifically, WakeMed’s demand would prevent UnitedHealthcare from providing information to members around quality and cost that might influence their decision to seek care from a provider other than WakeMed. Agreeing to WakeMed’s demands would also make it more difficult for employers to design plans around cost and quality. 

WakeMed is also seeking language in its contract that enables the health system to request our members to pay their cost share upfront well before a scheduled appointment at WakeMed, which we believe is unfair to the people we serve and can often lead to confusion and a poor experience for patients.

We have made numerous attempts to compromise and find solutions as part of good-faith negotiations.

We are offering WakeMed meaningful rate increases that help ensure it continues to be reimbursed at reasonable, market-competitive rates and that it is fairly compensated for the important care it provides to our members.

The rates we’ve proposed will help us maintain our ability to continue offering competitive health plans in the Raleigh area while also helping ensure our customers are paying fair, equitable prices when their employees use WakeMed for their health care needs.

We remain fully committed to engaging in productive, good-faith negotiations and are focused on our goal of renewing our contract with WakeMed so that our members have continued access to quality, affordable care at its hospitals and with its physicians.

We urge WakeMed to engage in good-faith negotiations and work with us to ensure the people we collectively serve have continued access to affordable care.

If we are unable to reach an agreement, WakeMed’s hospitals, employed physicians and specialists will be out of network for employer-sponsored, individual and Medicare Advantage plans, effective June 1, 2022.

This negotiation does not impact our Veteran Affairs Community Care Network (VACCN), which continues to remain in-network with WakeMed.

WakeMed’s primary care physicians (PCPs) and ambulatory surgical centers (ASCs) are on separate contracts and are not impacted by this negotiation. Both continue to remain in-network.

While WakeMed does not currently participate in our Medicaid network, it’s important to note that our Community Plan members continue to have access to WakeMed’s facilities and its physicians for all services as long as WakeMed agrees to see them. We reimburse WakeMed as an out-of-network provider for any services they provide our Community Plan members.

In the event WakeMed leaves our network, people enrolled in the UnitedHealthcare Medicare Advantage RPPO R1548 Dual Special Needs Plan (DSNP) as well as our Medicare Advantage group PPO benefit plan will continue to be able to receive services from WakeMed so long as the health system agrees to see them. Our DSNP RPPO and Medicare Advantage group PPO plans give our members the flexibility to see care providers that don’t participate in our network for no additional out-of-pocket cost beyond what they would pay to see a network provider. The reimbursement to care providers is the same as what they receive for treating patients enrolled in Original Medicare, regardless of network status.

The vast majority of providers nationwide agree to provide care for our group Medicare Advantage and our RPPO members, even when they don’t participate in our network.

Our commitment to the North Carolinians and employers we serve

We understand how disruptive it can be for our members if their hospital no longer participates in our network. But we also know that rising health care costs are putting pressure on family budgets and making it harder for people to afford the care they need.

On behalf of the people and employers we serve in Raleigh and the surrounding communities, please know we will stay at the negotiating table as long as it takes to reach an agreement. We hope WakeMed will join us there and approach the negotiating table in good faith so that the people we serve have continued access to quality care that is affordable.