WakeMed strikes a deal with UnitedHealthcare, but not for all its customers

After two years of negotiations, WakeMed has reached an agreement with the nation’s largest health insurance company to accept patients with its employer-sponsored commercial plans.

WakeMed and UnitedHealthcare signed a three-year contract that restores in-network access to WakeMed hospitals, outpatient clinics and specialty physicians for patients with the company’s employer-sponsored insurance.

Patients on those plans lost in-network status and favorable rates last fall, after lengthy negotiations failed to produce an agreement. The new contract takes effect Oct. 15.

The announcement of the deal late Thursday included caveats that underscore the complexity of the health insurance business.

The new contract does not include WakeMed’s hospitals, specialists and home health services for United’s Medicare Advantage plans. Those patients have been out-of-network for those WakeMed services since last fall.

At the same time, WakeMed’s primary care physicians, ambulatory surgical centers and PET imaging center never went out of network during the dispute between the two companies, and Medicaid coverage was not affected.

“Throughout these negotiations, WakeMed remained committed to reaching terms that would restore access for UnitedHealthcare members while appropriately recognizing the care and services WakeMed provides to our community,” Stephanie Sessoms, the health system’s chief financial officer, said in a written statement.

“The new agreement includes meaningful improvements in reimbursement and contractual terms and provides a more sustainable foundation for WakeMed and UnitedHealthcare to continue their commercial relationship over the coming years.”

Minnesota-based UnitedHealthcare issued a statement Thursday saying it looks forward to “collaborating with WakeMed in the years ahead to help provide North Carolinians and employers access to quality, affordable care.”

WakeMed has begun notifying patients, physicians and other providers about the new contract.

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