Options for Patients: Network Outage with UnitedHealthcare

Effective November 15, WakeMed hospitals, outpatient clinics, 210 PET, urgent cares and physician specialists are out of network with UnitedHealthcare (UHC) commercial and Medicare Advantage plans. Note: WakeMed Primary Care providers are covered under a separate contract and remain in network for all UHC plans. Additionally, WakeMed has an active contract with UHC Community Plan (Medicaid).

For patients who are covered by a UHC plan that is going out of network, this change impacts your financial responsibility for most services received at WakeMed. 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.

We understand how difficult this situation is for our patients and want to ensure you have the information you need to make decisions about accessing care during this time.

If you have an appointment at WakeMed after November 15, there are several options to consider:

• Apply for Continuity of Care: Patients who have already started to receive nonemergent care at our hospitals, outpatient clinics or physician specialists may be able to continue their care for a period of time after November 15, 2025, on an in-network basis, depending on the condition and other circumstances. Pre-authorization from UHC will be required. 

  To learn more about continuity of care benefit coverage, please review the CMS guidance on this topic (starting on page 11), which both WakeMed and UHC are required to follow. You can also contact UHC directly by calling the number on the back of your insurance card.

• Determine if You Have Out-Of-Network Benefits: We encourage all UHC plan participants to determine whether your individual plan includes out-of-network benefits, what is included, and the associated cost. For example, some UHC Medicare Advantage Group Retiree plans are exempt from out-of-network penalties.

  Using these out-of-network benefits will require pre-authorization from UHC. Additionally, WakeMed will require these patients to complete the Patient Financial Responsibility form and pay a deposit prior to receiving care. Contact UHC directly to determine the benefits associated with your plan.

• Pay the Additional Out-of-Pocket Costs: If you choose to obtain care from WakeMed on an out-of-network basis, you will need to sign a Patient Financial Responsibility form and pay a deposit prior to receiving care. For office visits, the deposit is up to $150; for procedures, the deposit is up to $1,000.

  To receive an estimate on your financial responsibility for care and services, please call 919-350-8359.

• Change Your Care to An In-Network Provider: Should you choose to transfer your care to another provider, we kindly ask you to let us know that you will not be keeping any appointments scheduled in the future. You may cancel an appointment via MyChart or by calling the appropriate office/service area.

Medicare Advantage Members: Regain Your Access to WakeMed for 2026

We know how important it is for you to have access to the providers and services you depend on at WakeMed. We also want to remind you that the Medicare Annual Enrollment Period is ongoing through December 7, 2025. During this time, you have an opportunity to choose another Medicare plan and retain your in-network access to WakeMed doctors and services for 2026.

A list of in-network plans is available here www.wakemed.org/insurance. If you need help, please contact WakeMed’s educational resource, Chapter, an independent Medicare advisory group. To get started with Chapter call 919-421-7997 or visit www.askchapter.org/wakemed.