The previous contract ended June 1, meaning WakeMed’s hospitals, outpatient clinics and physician specialists are no longer in network with UnitedHealthcare, which insures about 12 percent of the health system’s patients, according to the report.
WakeMed’s ASCs and primary care physicians will not be affected because they have separate contracts with UnitedHealthcare, but those contracts do not pertain to physicians and other specialists who work at the health system’s surgery centers.
According to UnitedHealthcare, a central point of contention was WakeMed asking for a 20 percent rate increase, which would increase premiums and out-of-pocket costs for about 20,000 of the company’s customers, according to The News and Observer. WakeMed rejects that claim, arguing it has not mentioned rates in more than a year and that UnitedHealthcare’s denial rates are at least five times higher than other large insurers such as Aetna, Blue Cross and Blue Shield, Cigna and Humana.
Negotiations are ongoing.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.