Duke University Health System and UnitedHealthcare are locked in contract negotiations with just days remaining on their current deal.
That means 172,000 Duke Health patients with United insurance could lose coverage with their doctor on Nov. 1, 2024, when the contract between the two sides expires.
One of those patients Durham resident Grace Sweeney. Surgery is her last option to fix painful problems with her back.
“I [have to] get the operation. It’s a matter of walking and being comfortable,” Sweeney told 5 On Your Side. “I have no choice.”
How that surgery would be paid for, suddenly became a big question mark when Sweeney got a letter from Duke alerting her to the United contract situation.
Sweeney had just scheduled surgery for Nov. 6, meaning if her hospital and insurer don’t reach a deal soon, Sweeney’s scheduled surgery would be out-of-network.
When she called United to find out more information, she said she was told not only that Duke would be out of network, but the nearest in-network facility was in Goldsboro.
“[That’s] about 70 miles away. I said, ‘excuse me?! That cannot be,’” Sweeney said about her conversation with United.
Sweeney spent days making calls, trying to keep her surgery plans.
“It was very emotional and really hard because what do I do,” Sweeney said. “Do I put off my operation? Do I remortgage my house because I [have to] pay out of pocket? How much is this gonna cost me?”
Finally, Sweeney confirmed her indemnity plan would cover 80% of her out-of-network costs. That’s about the same amount she expected to pay in-network.
“We don’t want patients to be in the middle of this,” Duke Health COO Dr. Thomas Owens told 5 On Your Side.
Owens said they’re working hard to reach a deal with United.
“We’re committed to lowering the cost of care, but for each part of the care we deliver, we want to be fairly reimbursed so that we can cover the cost of the services that we’re delivering,” Owens said.
United declined an interview, instead providing this statement: “Duke Health is already one of the most expensive health systems in the southeast and is significantly higher cost than other peer academic health systems in both North Carolina and neighboring states throughout the region. Despite this, we are proposing meaningful rate increases in the spirit of good-faith negotiation designed to reach an agreement. Unfortunately, Duke continues to demand price hikes that aren’t affordable for consumers. It remains our top priority to renew our relationship and ensure continued access to Duke Health. We urge the health system to provide a proposal North Carolina families and employers can afford. We believe quality care can also be affordable and the people of North Carolina deserve both.”
Duke denies the claim that they are one of the most expensive health systems in the Southeast and recently published an update about the negotiations.
UnitedHealthcare also published its own update earlier this month.
“Hospitals don’t really set prices in the way that I think most of the public thinks that they do,” said Ruth Lande with Undue Medical Debt, a nonprofit focused on the elimination of personal medical debt.
Hospitals mainly set prices based on what they get from two pots, according to Lande.
“It really comes from their government payers. For Medicare and Medicaid, the government publishes what they’ll pay,” Lande said. “On the private side, CIGNA’s and United’s and Aetna’s and all those, you’re sitting down, you’re having a negotiation either every year or every two or three years.”
Hospitals have agreements with dozens of insurers, as you can see on Duke Health’s website. It’s the same for UNC Health and WakeMed.
Usually you don’t hear anything about these negotiations, but you do more often when they get down to the wire or beyond.
Earlier this year, UNC Health and UnitedHealthcare didn’t reach a new agreement until three days before their contract was set to expire.
In 2022, WakeMed’s deal with UnitedHealthcare lapsed meaning for some people, WakeMed was suddenly out of network.
A WakeMed spokesperson told us for the five months that they did not have a deal with United in 2022, the hospital system worked in several different ways to make sure patients could keep getting care at insured or discounted rates.
Even though Sweeney said she figured her issue out, UnitedHealthcare asked 5 On Your Side for her name and information, saying they wanted to contact her to make sure she didn’t have any remaining questions.
Sweeney says they never called.
She loves her doctor at Duke and is glad she didn’t have to change coverage to stay with them, but she hates that these negotiations affect others financially and emotionally.
“You gotta think of the patients, because were human people here,” Sweeney said. “It’s more than just about the money issue of it. It’s not about the numbers, it’s about the people that need to have healthcare.”
For anyone who runs into this situation, remember the term “continuity of care.”
That ensures some things like pregnancy, long-term illnesses or other life-threatening diseases will continue to be covered even if the contract expires.
If you don’t automatically qualify for continuity of care, you can apply for it with your insurance provider.
A Duke Health spokesperson said its care team will assist patients with filling out the details of those continuity of care forms before they are submitted to United for approval.