RALEIGH, N.C. (WNCN) – Another dispute between UnitedHealthcare and a hospital that participates in its network is affecting approximately 10,000 people who use the insurance company’s community plan for managed Medicaid.
Four months ago, WakeMed decided to pull out of UnitedHealthcare’s network leaving thousands of patients in limbo.
The two sides have been negotiating since then in an effort to resolve that dispute.
Now, Duke Hospital has discontinued participation in UnitedHealthcare’s Community Plan.
It was a CBS 17 viewer who tipped us to what was happening at Duke Hospital after receiving a letter informing her that the UnitedHealthcare Community Plan for Medicaid wouldn’t be accepted beginning last Saturday.
The insurer said it has been in discussions with Duke to renew its Medicaid relationship for nearly one year.
The removal from the network affects about 10,000 Duke patients who use that particular plan.
In its letter to patients, Duke is telling affected Medicaid patients they must switch to one of four other managed Medicaid plans in order to stay in-network.
So, what happens to patients with previously scheduled surgeries?
In an email to CBS 17, Dr. Craig Albanese, the hospital’s chief operating Officer, said “90-day extensions are being provided to patients with scheduled surgeries and other personal health circumstances.”
In its written response, the hospital would not elaborate on why it decided to discontinue its network affiliation with UnitedHealthcare.
For its part, UnitedHealthcare said “if Duke agrees to see you during this dispute, it will reimburse the hospital as an out-of-network provider.”
UnitedHealthcare said “Its top priority is to restore network access to Duke,” and “it’s committed to meeting with the system as often as it takes to reach a new agreement.”
This comes days after it said its top priority was to move negotiations forward with WakeMed.
CBS 17 previously reported that UnitedHealthcare said on its website it said “In our recent discussions with WakeMed, both organizations agreed to an accelerated approach to restore network access to the health system for the people we collectively serve. We have resolved all of the key language in our contract…Our top priority is to move this negotiation forward quickly and end the disruption our members have experienced. That is why we delivered a comprehensive counterproposal to WakeMed within 72 hours of receiving the health system’s proposal.”
The dispute does not affect UnitedHealthcare’s employer-sponsored, individual and Medicare Advantage plans, including its Dual Special Needs Plan, which continue to remain in-network with Duke.