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WakeMed, UnitedHealthcare at Odds Over Payments

Posted February 26, 2007
Updated February 27, 2007

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— Shawn Belcher said she was floored when a letter came in the mail recently from her insurance company, UnitedHealthcare, announcing it was terminating its contract with WakeMed.

WakeMed is the only hospital with which Belcher'sdoctors do business. The letter meant Belcher and other UHC cardholders would no longer be covered if they continued using WakeMed.

"It's like penalizing me for picking the wrong health-care group,” Belcher said.

UHC officials claim they're charged more for services than their competitors are charged. They said they want a reduction by midnight Wednesday or they’ll cut off WakeMed completely.

“Their contract as it exists today is what it is. It's a contract,” said WakeMed spokeswoman Debra Laughery. “We can't right now afford to reduce what they pay us."

UHC officials issued a statement in response saying: "WakeMed's reimbursement rates continue to be among the highest in the Raleigh market. We remain open to any future discussions with WakeMed with the goal of keeping health care affordable for our members and employer-group customers."

“For them to ask WakeMed to charge them accordingly with their competitor, Blue Cross Blue Shield, I don't think that's a really bad request,” Belcher said.

Both sides said they will continue to negotiate. If they can’t work out the dispute, however, Belcher said she and her family would be shopping for another health-care provider.

UHC customers will have other options if a resolution can't be reached. The company contracts with five other local hospitals, including nearby Rex Hospital. But WakeMed is the only hospital in Wake County with a Level 1 trauma center and the highest level intensive care nursery.

UHC officials said they encourage any of members with questions or concerns to call the member service number on the back of their ID card. Wake Med has set up a hotline for concerned community members at 919-350-CARE (2273).

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  • Nachoman Feb 28, 2007

    I spoke with my HR rep today. I was told that this would not qualify as a change so I would not be allowed to switch providers. I've been thinking about changing for a few years, as many procedures covered by Blue Cross are not covered by UHC. When I sign up for next years benefits it will be Blue Cross not UHC. I had a doctors appointment this morning. My doctor said he prefered Wake Med over other area hospitals as a professional and personally.

  • Wake1 Feb 27, 2007

    Hanginround - what does Magnet mean? Does it equate to level 1 trauma service???? Is it tru that if a Rex employee gets hurt bad in an auto accident right outside your doors, that employee would be taken to WakeMed? I think so - I know it has happened. For the record, WakeMed is taking steps to make sure UHC insureds do continue to get excellent care!

  • Nurse on the run Feb 27, 2007

    cmrrs111, I haven't had time to read all of the postings, as I am working. However, wouldnt this incident be considered a 'signifcant change' or in insurance verbage a sentinel type event within the insurance structure? I think I would approach my HR dept and talk about changes in benefits. Raising the issue here, I am sure it does significantly impact some other employees. I am not sure if Duke is a par facilty within the UHC network but it might not be a bad idea to approach the UHC end of it as well. Working out a contract and going through the credentialing process to be a par provider/in network carrier takes about 60 to 90 days. I think I would approach from that angle. Good luck with all of your endeavors!!

  • cmrrs111 Feb 27, 2007

    Hanginround - i appreciate your honesty. i went back and read every single posting today. i was appalled at their posting to others on here just stating what they knew. my family have been treated at WM, Rex, UNC, etc. Luckily, it will not be a great impact on us. There is no change in our providers or our coverage except for going to WM. I do feel that it is unfortunate for those who are receiving ONGOING care thru WM, however, UHC has promised to continue that for those who need it. I know that the "charity" issue has been brought up, let's just say it, with all of the illegal aliens in the area it is costing patients with insurance. But WM sees it as charity. I think that needs to change to some extent. I explained in my earlier posting the information that we received from HR in regards to this dispute.
    WakeMed IMPOSES Increase to UHC
    32% higher for in-patient admissions
    142% higher for emergency room services
    52% higher for out-patient services

  • Nurse on the run Feb 27, 2007

    cmrrs111...RITFL!!!... I'll bet you hit that one on the head...I'll bet his/her boss knew he/she was wasting time on the computer instead of doing patient care like they are supposed to wouldn't get too many brownie points.
    I think I read a post earlier about the lousy patient care... I dont see Wake Med getting accredited with a "Magnet" award... However Rex was issued this honor last year..
    I have personal experience with both Rex and WM... Rex is the better of the 2 and Duke possibly 2nd.
    I had UHC years ago.. didnt have many problems out of them.. being self employed I chose BCBS... has a better structure. Good luck with your issues... hope jeneric sees the light..

  • cmrrs111 Feb 27, 2007

    i think that everyone has made some valid points on this issue and we all conclude that it is a MESS! however, one question to jeneric43, do you have UHC or are you just a WM employee trying for brownie points (seeing that you are vehemently defending WakeMed)

  • Nurse on the run Feb 27, 2007

    Wake Med is what it is... opinions are like elbows...we all have one....

  • jeneric43 Feb 27, 2007

    Hanginround, truth hurts huh.

  • Nurse on the run Feb 27, 2007

    jeneric43 Do you work??... why dont you go do something then?. Not everyone thinks as highly about WM as you do!...I am sure others will agree!

  • jeneric43 Feb 27, 2007

    TechRescue-it took multiple years and WakeMed was turned down multiple times for an Air Ambulance. If you questioned the Certificate of Need WakeMed received for the Air Ambulance, why don't you question the folks who issued the Certificate of Need and not bash WakeMed. They obviously saw that we finally qualilfied and had a valid need for one.