Cape Fear Valley Medical Center ends United Healthcare's Medicare Advantage insurance coverage

The Cape Fear Valley Medical Center in Fayetteville has ended only its United Healthcare Medicare Advantage insurance coverage, affecting thousands of patients. This does not apply to other United Healthcare plans.

The hospital said there is a "good reason" for the change, but patients are still scrambling to find new care providers.

The hospital stopped accepting United Healthcare Medicare Advantage plans on July 25, affecting around 17,000 policyholders.

Sandra Cordes, whose insurance provider is United Healthcare Medicare Advantage, said the news is devastating.

"I just had a heart cath two years ago at Cape Fear Valley, and it was covered all except for a $125 co-pay," Cordes said.

Now that Cape Fear is no longer in the United Healthcare Medicare Advantage network, patients with United Healthcare Medicare Advantage will have to travel to Lumberton, Southern Pines and Goldsboro for hospital care.

Cordes said that's an additional financial and emotional hardship.

"We live on a fixed income, so we don't have money for extra gas to drive to these other places to have testing done," Cordes said. "It's a hardship on our family because instead of taking off an hour or two to be with us doing our surgery, they got to take the whole day off."

Hospital administrators said doctor's offices and other medical providers with ties to Cape Fear Valley Health System still accept United Healthcare Medicare Advantage insurance.

The hospital said that the dispute with United Healthcare Medicare Advantage centers on three main issues including:

• Excessive denials of claims by United Healthcare Medicare Advantage
• Unacceptable delays and denials of authorizations for care
• Rates with sub and post-acute providers so low that some will not take United Healthcare Medicare Advantage patients when they are ready to leave the hospital.

WRAL News contacted United Healthcare and received the following statement.

“Despite successfully negotiating and reaching agreement on a new multi-year contract less than a year ago, Cape Fear Valley Health chose to end our hospital contract for our Medicare Advantage plan. Cape Fear delivered two unreasonable proposals as a condition of continuing our relationship, including demands that would make its hospitals 15% higher cost than any hospital in our Medicare Advantage network in North Carolina. We remain committed to continued discussions should Cape Fear join us at the negotiating table with a realistic proposal. However, our focus at this time is ensuring North Carolina seniors have access to the care they need through either continuity of care or a smooth transition to a new provider.”

United Healthcare Medicare Advantage will cover emergency room visits at Cape Fear Valley Medical Center, but patients may be responsible for a portion of the bill if admitted to the hospital.

Cape Fear Valley administrators acknowledge the situation might be confusing for patients. So they've set up a hotline (910) 615-2222 and email address CFVUHCIssues@capefearvalley.com to answer questions.

Editor's note: A previous version of this story stated Cape Fear Valley Medical Center no longer accepted United Healthcare insurance coverage, but it did not specify which plan. The hospital no longer accepts United Healthcare Medicare Advantage insurance coverage. It will accept other United Healthcare plans.