UNC Health extends Blue Cross NC, but remains at odds with UnitedHealthcare

UNC Health has extended its agreement with Blue Cross Blue Shield North Carolina by four years, continuing coverage for members of the state’s largest health insurer.

“Working with Blue Cross NC for many years without interruption has provided stability and peace of mind for UNC Health patients and providers,” UNC Health said in a statement Wednesday. The insurer has covered North Carolina residents since 1933, and Blue Cross NC today boasts more than 4.2 million members.

But while Blue Cross NC members are assured coverage at UNC Health facilities, the same can’t be said for most patients with UnitedHealthcare plans. If UNC Health and UnitedHealthcare don’t reach a deal by April 1, a lapsed contract would make UNC Health out-of-network for about 200,000 people, UNC Health spokesperson Alan Wolf said in a phone interview.

These patients would need to either switch insurers or physicians to escape steeper out-of-pocket costs for UNC Health services.

The dispute, which dates back months, centers around UnitedHealthcare’s reimbursement rates, which UNC Health believes are too low to compensate for elevated labor costs and inflated supply prices. Patients have also complained about “improper denials and unnecessary delays in patient care that are created by United Healthcare,” Wolf said, adding “those denials and delays get in the way of the care that our providers and clinicians want to offer.”

This isn’t UnitedHealthcare’s first protracted disagreement with a Triangle-based provider. In 2022, members were out-of-network at WakeMed for more than five months until the two sides signed a new three-year contract.

Both UNC Health and UnitedHealthcare say they are continuing negotiations with in-person meetings scheduled over the next several weeks.

In an email Wednesday, UnitedHealthcare spokesperson Catherine Farrell said the most recent UNC Health rate proposal “would significantly increase health care costs and is not affordable or sustainable for North Carolinians and employers.” She added that the insurer has already proposed rate increases “that ensure the health system continues to be reimbursed at market-competitive rates.”

Farrell emphasized the insurer has a strong record of extending provider contracts, pointing out its network includes 160 North Carolina hospitals. UNC Health has 19 hospitals and more than 900 clinics statewide. A handful of these facilities, including hospitals in Morganton and Jacksonville, will remain in-network regardless of the negotiations, as will the insurer’s contract with UNC Health for Medicaid.

If the April 1 deadline passes without a deal, UnitedHealthcare members who are in the middle of treatment at a UNC Health facility may be eligible for continuity of care, which extends in-network benefits for “a period of time,” Farrell said.

Medicare Advantage patients have until the end of the month to switch insurers. “I would encourage them to start considering other options now,” Wolf said.