Another NC hospital and insurance company threatening to end in-network coverage

Sean Coffey Image
Thursday, December 14, 2023
Another NC hospital and insurance company threaten to pull coverage
People with UnitedHealthcare or Cigna insurance in NC could find themselves needing a new doctor (or paying out-of-network premiums) in 2024.

RALEIGH, N.C. (WTVD) -- We're digging deeper into the future of health care coverage in North Carolina, as another massive health system and insurance company try to come to terms on a future contract.

On Tuesday, ABC11 first reported on the contract dispute between WakeMed and insurance company Cigna that could lead to a loss in coverage for Cigna members on January 1st. Now, ABC11 has also confirmed that a similar dispute is taking place between UNC Health and UnitedHealthcare -- but with a deadline set for April 1st.

"Be a good partner, help us, you know, recover, be part of the solution," said Steve Lawler, the President and CEO of the North Carolina Healthcare Association. Lawler ran ECU Health in Greenville, sitting in the room for these types of negotiations, before turning his focus to representing hospitals and health systems with the NCHA. He said the negotiations can have a real impact on the patients caught in the middle.

"If somebody has an OBGYN that they've been going to for prenatal care, and all of a sudden they're out of network, you know, that definitely creates a level of concern and stress during a situation that's already stressful," he said.

If an agreement isn't struck by the April 1st deadline, more than 200,000 UnitedHealthcare members could suddenly find themselves out-of-network at UNC Health locations, meaning a spike in costs if they were to stay with their current providers.

ABC11 reached out to UnitedHealthcare, which said UNC Health's current stance in negotiations would mean a $570 million increase in healthcare costs over the life of their proposed three-year contract. The company said it is doing everything it can do avoid a scenario where people fall out-of-network.

"Our top priority is utilizing the time remaining on our contract to reach an agreement that ensures uninterrupted access to care that is affordable," a UnitedHealthcare spokesperson said. "We will remain at the negotiating table as long as it takes to reach an agreement. We urge UNC Health to join us there and deliver a realistic proposal that is affordable for North Carolina families and businesses."

On the other hand, UNC Health blames inflation and complicated rules developed by UnitedHealthcare for the dispute. The hospital group set up this website with more information about the dispute. They also sent the following letter to UnitedHealthcare patients in the hospital system.

Representatives for UNC Health contend that UnitedHealthcare hasn't engaged in good faith negotiations.

"Unfortunately, United has refused to come to the table and negotiate a new and fair agreement," a UNC Health spokesperson said. "We hope they will start more serious negotiations well before our current contract ends on April 1."

Patient advocates said a potential lapse in coverage -- or changing providers -- can be a source of enormous stress to those caught in the middle.

"Let's say you have a terminal diagnosis and you want to stay with that doctor, but they are no longer under the provider list, this can be absolutely detrimental to a patient," said Rachel Vaughters, a board-certified patient advocate in Raleigh.

Despite the current impasse, there's still some hope that both sides can find common ground for the good of the people who could soon find themselves in limbo.

"When it's all said and done, if we can get to that point of shared incentives and a commitment to be part of the solution, you know, these things can be worked through," Lawler said.