UHC claims ECU Health refused to continue negotiations

ECU Health refused a request that would have allowed clients of a major health insurance company to continue paying existing rates for medical services while negotiations on long-term rates continued, the company said Thursday.

UnitedHealthcare's statement came one day after ECU Health announced its contract with UHC had expired because the provider and insurer could not reach an agreement on reimbursement rates. The result means that UHC clients must pay higher out-of-network costs for many services at ECU Health.

Some exceptions, such as emergency care, will continue to be covered at in-network rates at ECU Health. Some ECU Health-affiliated physician practices, such as the legacy ECU Physicians, will remain in the network until Feb. 15, 2027.

UnitedHealthcare announced on its website that it sent a proposal to ECU Health on April 28 that "included meaningful rate increases that would continue to reimburse the health system above market averages."

Extending the existing contract would have allowed for continued negotiations while continuing access to the ECU Health system, UHC said.

"ECU Health refused, presumably to use its patients as leverage to pressure us to agree to the significant price hikes it is seeking," the insurer said.

ECU Health on Thursday responded that it worked in good faith with UHC, but the time had come to end the relationship.

"For nearly a year, ECU Health worked in good faith to reach an agreement with UnitedHealthcare to preserve in-network access for our patients," said Brian Wudkwych, ECU Health spokesman. "Throughout this process, we have made every effort to engage constructively and move negotiations forward. However, those efforts have been met with delays, limited responsiveness and proposals that do not reflect the realities of providing care in eastern North Carolina."

UnitedHealthcare said it attempted to engage with ECU Health leadership but was continually referred to an outside consultant negotiating for the system.

"We met with ECU Health's consultant on April 29 to discuss our latest proposal as part of our efforts to move our negotiation forward," the insurer said. "We were informed they would not be responding to our proposal and proceeded to cancel future meetings pertaining to our negotiation."

UnitedHealthcare said that under ECU Health's proposal, payments to ECU Health Medical Center would be approximately 40 percent higher than the average of other academic medical centers in the state by 2028.

Its rate proposal for UnitedHealthcare's Medicaid plan and its proposed increase for Medicare Advantage plans would make them among the most expensive in the state, the insurer said.

Wudkwych said UnitedHealthcare's proposal would have further reduced reimbursement, undermining ECU Health's ability to sustain services.

"We want to be clear that this is not the outcome we hoped for," Wydkwych said.

"Like many rural health systems, ECU Health is facing rising costs, workforce shortages and ongoing changes in how care is delivered," Wydkwych said. "At the same time, reimbursement from UnitedHealthcare has not kept pace with those realities. For years, ECU Health has absorbed increasing labor, supply and infrastructure costs while payments remained largely stagnant."

While both entities are offering UnitedHealthcare clients options to continue receiving health care, neither said when or if reimbursement negotiations will resume.