Protecting Your Patient Rights
WakeMed is Out of Network for Commercial & Medicare Advantage Plans
Commercial contract negotiations continue in hopes of reaching an agreement.
At WakeMed, we never compromise when it comes to delivering high-quality patient care. In the interest of patients and our community, we negotiate insurance agreements in good faith and do not back down from the commitments we make. In return, we only ask that insurers honor their side of those agreements.
For nearly a year, WakeMed has been working in good faith with UnitedHealthcare to come to a contract agreement that ensures your continued in-network access to high-quality care and services with the WakeMed providers you know and trust. Unfortunately, we have so far been unable to reach an agreement.
As a result, WakeMed hospitals, outpatient facilities and physician specialists are now considered out of network for UnitedHealthcare. This change will impact out-of-pocket costs for most patients with UnitedHealthcare insurance. If you have an upcoming appointment at WakeMed, please review your options and next steps.
Please note that WakeMed primary care physicians are not included in these current negotiations and will remain in network.
If You Need Emergency Care
Please be aware that all patients, regardless of their insurance status, may still seek treatment at any of WakeMed’s eight Emergency Departments, including the county’s only Children’s Emergency Department.
Under the No Surprises Act, emergency services must be covered by the patient’s insurer without prior authorization, regardless of whether the facility/provider is in-network or out-of-network, and without regard to any other term or condition of the patient’s insurance plan or coverage.
This means that patients will pay the same amount for emergency care and post-stabilization services (including inpatient admission from the Emergency Department, if needed) as they would if WakeMed were in-network with their insurance plan. Patients do not need to transfer to an in-network facility once the emergency medical condition is stabilized to benefit from the financial protections of the No Surprises Act.
Important Reminder for Medicare Advantage Members
We recommend UnitedHealthcare Medicare Advantage members who are able to make changes to their coverage for 2026 strongly consider doing so during annual Medicare Advantage annual open enrollment, which is ongoing now through December 7, 2025.
This annual enrollment season, WakeMed is collaborating with Chapter, an independent Medicare advisor, to offer our patients a trusted Medicare educational resource. Chapter’s licensed advisors are available to answer questions and help you choose a Medicare plan that meets your health and wellness needs. This optional service is available at no cost to you. To learn more, call 919-421-7997 or visit askchapter.org/wakemed.
Where Negotiations Stand Currently
While our contract has not been extended, and WakeMed is currently out of network, WakeMed and UnitedHealthcare have agreed to continue negotiations around commercial contracts and meetings are ongoing. WakeMed remains open to reconvening Medicare Advantage negotiations should UnitedHealthcare offer reasonable language and terms.
We will continue to work in good faith with UnitedHealthcare to reach resolution, and we will also help you navigate any insurance-related challenges to help you get the care you need.
What These Negotiations Are About
In 2022, WakeMed and UnitedHealthcare reached an agreement that was meant to address UnitedHealthcare’s excessive practice of denying payment for care that we provide patients.
Unfortunately, UnitedHealthcare has not honored the contract they agreed to and instead have consistently put the needs of their shareholders above those of their members – our patients.
Over the past three years, UnitedHealthcare has continued to deny care at rates 2-3 times higher than other insurers. These denials often occur after care has already been provided, leaving patients caught in the middle and requiring WakeMed to dedicate significant resources to disputing these denials, on your behalf.
A report provided by UnitedHealthcare for a recent twelve (12) month period confirmed $105 million in commercial and Medicare Advantage claims for hospital and physician services provided by WakeMed were denied by UnitedHealthcare. And so far, UnitedHealthcare has not agreed to eliminate or reduce this volume of lost reimbursement to WakeMed. As a not-for-profit health system, WakeMed depends on receiving fair, timely reimbursement for the care we provide to our community. We’re asking UnitedHealthcare to agree to a contract that:
- Protects your relationship with your WakeMed physician
- Ensures access to medically necessary care
- Requires UnitedHealthcare to honor the terms of our agreement
Ultimately, this is about making sure that our patients get the benefits you are entitled to and that your care decisions are based on medical need—not corporate profit.
Resolving these issues remains our priority and focus and has – to this point – precluded us from evaluating any comprehensive contract proposal. UnitedHealthcare’s most recent proposal offered no measurable increase in reimbursement rates for the next four years – despite expected increases in labor, supply and equipment costs.
Since 2016, hospital operating costs have climbed nearly 36 percent nationwide – and these trends continue. As a UnitedHealthcare employer and member, your costs for coverage have likely increased in recent years as well.
During the past nine years, our reimbursement rates with UnitedHealthcare have increased very modestly, and far below our cost increases. As a result, WakeMed is currently being reimbursed by UnitedHealthcare at 2019 levels, while WakeMed is paying 2025 costs for wages, supplies, pharmaceuticals, etc. Again, what they are charging you and your employer have certainly kept pace – and those additional revenues coupled with denials of medically necessary services are driving UnitedHealthcare’s record profit margins.
UnitedHealthcare’s own publicly available hospital rate data highlights the significant differences between WakeMed’s payment rates for inpatient and outpatient services and what other Triangle-area health systems are paid for the same services.
|
C-Section Delivery |
WakeMed is paid 9% lower |
|
ER Observation (but no admission) |
WakeMed is paid 15% lower |
|
Scheduled Cardiac Electro Conversion |
WakeMed is paid 40% lower |
|
Colonoscopy |
WakeMed is paid 6% lower |
|
Atrial Fibrillation |
WakeMed is paid 15% lower |
|
Central Venous Access Line Placement |
WakeMed is paid 32% lower |
This means that if WakeMed and UnitedHealthcare are unable to reach a commercial agreement by November 15, 2025, employers and individuals will pay much more for care that will be directed away from WakeMed to other, higher-cost health systems in the Triangle area.
In the most recent proposal WakeMed sent to UnitedHealthcare, we asked for reimbursement recoveries related to inappropriate denials for services provided – essentially for certain policies that add no value to the patient and increase our costs to comply be ‘turned off.’
We also asked for rate adjustments based on the Bureau of Labor Statistics’ Consumer Price Index (CPI), an independently calculated measure of cost inflation, specifically applicable to hospital and physician costs. Using a CPI-based factor is reasonable and verifiable and will avoid protracted future negotiations that only disrupt our patient’s access to care.
The combination of reducing denials of medically necessary services that WakeMed has already provided, and CPI based rate adjustments, is a very reasonable request that will continue to position WakeMed as the low-cost health system in the area.
How You Can Help
If you want to continue receiving in-network care from WakeMed, help us negotiate on your behalf by:
- Calling UnitedHealthcare at the number on the back of your health insurance card. Ask UnitedHealthcare to reach a new agreement that maintains your in-network access to WakeMed and protects the relationship you have with your physician.
- If you have employer-sponsored health insurance, talking to your employer or HR representative about your desire to have continued access to WakeMed’s high-quality caregivers and services. You can also suggest your employer call WakeMed’s Managed Care Department at 919-350-7983.
We will continue to keep you updated on our negotiation progress. Rest assured; we are working hard to resolve this issue as we want to continue being able to serve your health care needs.
FAQs
All UnitedHealthcare commercial and Medicare Advantage insurance plans will go out of network with WakeMed hospitals, outpatient facilities, urgent care and specialty care WakeMed Physician Practices.
Please note that WakeMed primary care physicians and MyCare365 locations are covered under a separate contract and are not impacted by these current negotiations. WakeMed’s retail pharmacies are covered under a separate contract and will remain in network for UnitedHealthcare members having Part D coverage.
The UnitedHealthcare Community Plan (Medicaid) is also excluded. However, UnitedHealthcare Medicare patients who have dual coverage with UnitedHealthcare Medicaid coverage will be impacted as UnitedHealthcare Medicare is your primary coverage.
If we are unable to reach agreement on a new, reasonable contract, individuals covered under a UnitedHealthcare insurance product will likely see an increase in their out-of-pocket costs if they choose to receive non-emergency medical services at a WakeMed hospital, outpatient facility or at a specialty WakeMed Physician Practices location. Care will be considered out of network and out-of-pocket costs for most patients with UnitedHealthcare insurance will increase.
If you are a UnitedHealthcare Medicare Advantage plan member with an upcoming appointment, please visit this page to read more about your options and next steps.
Please note: all patients, regardless of their insurance status, may still seek treatment at any of WakeMed’s eight Emergency Departments, including the county’s only Children’s Emergency Department.
If you are covered under a UnitedHealthcare commercial insurance plan, you can call 919-350-8359 to speak with a member of our Patient Financial Services team.
It is also beneficial to speak directly with UnitedHealthcare to understand what they will cover when your care team is out of network. Ask what level of out-of-network benefits you have. Based on your individual plan, using an out-of-network provider or facility may lead to higher costs for you.
If you have a UnitedHealthcare Medicare Advantage plan and want to learn about your options to retain your in-network access to WakeMed doctors and services for 2026, we encourage you to contact our Medicare educational resource, Chapter. Medicare Annual Enrollment begins October 15, and their Medicare advisors can help you understand your options and choose a plan for 2026 that fits your health care needs. With the exception of UnitedHealthcare, all of our Medicare Advantage plans have agreements in place for 2026. Call Chapter at 919-421-7997 or visit www.askchapter.org/wakemed.
In 2022, WakeMed and UnitedHealthcare entered into an agreement aimed at resolving the excessively high rate of claim denials WakeMed had been experiencing. This new agreement required UnitedHealthcare to use nationally recognized criteria, instead of their own, when reviewing the medical necessity of care.
Unfortunately, the terms of the contract have not been followed as expected, and WakeMed is once again faced with higher-than-acceptable denial rates for covered care and services that are deemed medically necessary by a physician. Appealing these denials takes considerable resources and adds to the cost of providing the health care that our patients need.
Further, the reimbursement that WakeMed agreed to accept – and UnitedHealthcare agreed to pay – on your behalf, is not being paid by UnitedHealthcare. The difference is in the tens of millions of dollars annually, which significantly impacts the financial health of a not-for-profit health system like WakeMed.
Unfortunately for sick patients across the country, these issues with UnitedHealthcare are not just a ‘WakeMed problem’. We are not the only health system asking UnitedHealthcare to honor their contractual agreements and ensure our patients’ covered benefits are not being denied.
Whether it is reporting record profits for the benefit of stockholders, U.S. Department of Justice investigations into UnitedHealthcare executives, denials of potentially life-saving care, or multiple health systems going out of network due to contract battles, the news is full of articles about ongoing issues and negative stories related to UnitedHealthcare. Time and again, UnitedHealthcare has put profit above the needs of their members – our patients.
UnitedHealthcare is trying to balance their margins on the backs of patients. This is the real reason health care costs are rising. In fact, UHC reported over $10 billion in earnings in the first two quarters of 2025 and $32.3 billion for calendar year 2024.
We understand that a potential network outage can be disruptive – and we want to assure you it is always our hope to resolve these issues without interrupting our patients’ care. At the same time, we must do all we can to ensure our contracts with insurance companies protect the relationships between our patients and their physicians, allows WakeMed to receive adequate reimbursement for services provided and supports our mission to care for all members of our community.
WakeMed accepts many other insurance plans, and this list is readily available on our website. We encourage patients to visit this web page to explore the other options we accept.
All of WakeMed’s hospitals, stand-alone emergency departments, urgent cares, outpatient services including imaging, laboratory, rehabilitation, wound care, sleep center, 210 PET and outpatient surgery centers are affected as are the WakeMed Physician Practices specialists.
WakeMed Primary Care practices and physicians, including MyCare 365, operate under a separate contract, which is not included in this negotiation. Additionally, WakeMed’s retail pharmacies will remain in network for UnitedHealthcare Part D members.