Dispute between insurer and doctors will mean higher bills for thousands in the Triangle

Mar. 2--Thousands of people in the Triangle area who are covered by the nation's largest private health insurer are losing anesthesia coverage at several of the area's main hospitals.

As of March 1, the more than 80 anesthesiologists of American Anesthesiology of North Carolina -- the Mednax-affiliated provider of anesthesia, pain management and critical care in the Triangle -- will no longer be in-network under UnitedHealthcare. Southeast Anesthesiology Consultants in Charlotte is also affected.

After a disagreement last month over pricing -- first reported by health news website Healthcare Dive -- the physician-staffing firm Mednax will no longer be part of the UnitedHealthcare network in North Carolina, South Carolina, Arkansas and Georgia.

Mednax focuses on services in anesthesia, neonatology and obstetrics in urban and rural areas. Southeast Anesthesiology Consultants in Charlotte is also included.

UnitedHealthcare members will still have access to Mednax providers, but will pay significantly more due to "out-of-network" pricing.

"We want to keep Mednax in our network at rates that reflect fair market prices and that promote an affordable, predictable experience for our members," said a UnitedHealthcare spokesperson. "Mednax physicians are being paid more than double the median rate of in-network physicians providing similar services in these states, which drives up the cost of care for consumers."

According to UnitedHealthcare, a $40.6 million reduction in overall health care costs would result among the four combined states if Mednax were paid at the median rate of other competing in-network physicans. This reduction would mean savings for self-funded employers, lower premiums and out-of-pocket costs for patients.

UnitedHealthcare said it had submitted a proposal to reimburse Mednax at rates similar to other providers in these four states.

In a statement to The News & Observer, Mednax called the insurer's statements "highly misleading." According to them, numerous discussions between the companies this year have been fruitless and UnitedHealthcare "reinforced its unacceptable payment terms on a 'take it or leave it' basis."

"It is important to note that MEDNAX has requested on multiple occasions a 60-day extension to avoid the out of network disruption to patients and allow more time for negotiations, each time United has rejected these requests," Mednax said in the statement.

The North Carolina Department of Insurance told The N&O that UnitedHealthcare estimates that 11,141 customers and 176 physicians in North Carolina could be affected by the change.

UnitedHealthcare said that if they are unable to reach an agreement, the following providers would be out-of-network for employer and individual insurance plans: Pediatrix Medical Group of North Carolina in the Charlotte area on June 1, American Anesthesiology of South Carolina on Nov. 15 and Obstetrix Medical Group of Coastal Carolina in Jacksonville on Dec. 15.

In the Triangle, Anesthesiology of North Carolina serves the following WakeMed Health and Hospitals, Duke University Health System and UNC Health hospitals and care centers:

Raleigh

-- Blue Ridge Surgery Center -- 2308 Wesville Court

-- Capital City Surgery Center -- 23 Sunnybrook Road Suite 100

-- Holly Hill Hospital -- 3019 Falstaff Road

-- Michael Law M.D. Aesthetic Plastic Surgery -- 10941 Raven Ridge Road Suite 101

-- North Carolina Heart and Vascular Hospital -- 2800 Blue Ridge Road

-- Raleigh Access Center -- 3031 New Bern Avenue Suite 100

-- Raleigh Orthopaedic Surgery Center -- 3001 Edwards Mill Road Suite 100

-- UNC REX Hospital -- 4420 Lake Boone Trail

-- Rex Surgery Center of Wakefield -- 11200 Governor Manly Way Suite 110

-- Surgical Center for Dental Professionals -- 2620 New Bern Avenue

-- WakeMed North Hospital -- 10000 Falls of Neuse Road

-- WakeMed Raleigh Campus -- 3000 New Bern Avenue

Cary

-- WakeMed Cary Hospital -- 1900 Kildaire Farm Road

Wake Forest

-- Carolina Pain & Spine -- 110 Capcom Avenue Suite 200

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