Duke Hospital And United Healthcare: Are You Covered?

As of October 15, 2022, Duke Health no longer accepts the UnitedHealthcare Community Plan. This means that UnitedHealthcare Community Plan is no longer accepted by Duke doctors, clinics, or hospitals. However, Duke Health does contract with most major health insurance carriers and transplant networks. They are considered in-network for United Healthcare Compass in the Triangle area, and some Duke providers may be in-network for United Healthcare products. Patients with certain high-level care needs, such as pregnancy and cancer treatments, can continue receiving services at Duke under their UnitedHealthcare Community Plan for 90 days following the agreement expiration date.

UnitedHealthcare Community Plan no longer accepted

Duke Health has not accepted UnitedHealthcare Community Plan since October 15, 2022. This means that UnitedHealthcare Community Plan is no longer accepted by Duke doctors, clinics, or hospitals. If you wish to continue seeing Duke providers at Duke locations, you must switch to a North Carolina health system that includes a different Medicaid plan in which Duke Health participates.

If you don't switch your plan, you will remain enrolled with UnitedHealthcare Community Plan and will no longer be able to continue with your Duke doctors. Your old coverage will remain in place until the end of the month, and your new plan coverage will begin on the first of the following month. You will receive a new Medicaid ID card in the mail, which you will use to obtain healthcare services.

If you have certain high-level care needs, such as pregnancy or cancer treatments, you can continue receiving services at Duke under your UnitedHealthcare Community Plan for 90 days following the agreement expiration date, which was January 12, 2023. If you wish to continue with your Duke provider after the 90-day extension, you must choose a different Medicaid insurance plan.

Duke Health contracts with most major health insurance carriers and transplant networks. They participate in UnitedHealthcare Medicare Advantage (HMO, PPO, and SNP plans) but do not include mental health, home health, or home infusion services. Duke is considered in-network for Blue Cross Blue Shield Blue Local with Duke Medicine and WakeMed, Coventry One, and United Healthcare Compass in the Triangle area.

United Healthcare Compass accepted in Triangle area

As of 2015, United Healthcare Compass was accepted in the Triangle area. Duke Health was considered "in-network" for United Healthcare Compass, Blue Cross Blue Shield Blue Local with Duke Medicine and WakeMed, Coventry One, and United Healthcare Compass. These products are available by county, so it is important to check what your options are in your specific county.

Duke Health contracts with most major health insurance carriers and transplant networks. However, Duke Health does not participate in UHC plans on the Health Insurance Marketplace. They also do not participate in United Healthcare Medicare Advantage (HMO, PPO, and SNP plans) for mental health, home health, or home infusion services.

In 2024, there were reports of a deadlock between Duke Health and United Healthcare, with some physical therapists no longer able to afford to see UHC patients. However, more recent reports suggest that Duke has signed a new contract with United Healthcare, resolving the issue.

In the Triangle area, there is also a healthcare provider called Compass Health Direct Primary Care in Durham. They offer monthly subscriptions instead of insurance.

United Healthcare Medicare Advantage plans

UnitedHealthcare's Medicare Advantage (Part C) plans offer all the benefits of Original Medicare (Part A and Part B) with predictable prescription costs. Many plans also include $0 annual physical exams, $0 lab tests, and $0 preventive care like mammograms and colonoscopies. The plans also offer dental, vision, and hearing coverage.

UnitedHealthcare's Medicare Advantage plans are of different types, including HMO, PPO, and SNP plans. HMO plans usually only pay for providers within the plan network, while PPO plans cover providers both in and out of the network. PPO plans also give you the freedom to see any doctor nationwide that accepts Medicare, without referrals for specialist or hospital visits. A Special Needs Plan (SNP) is a type of Medicare Advantage plan that serves people with special healthcare or financial needs. SNPs have a provider network.

UnitedHealthcare also offers Institutional-Equivalent Special Needs Plans (IE-SNPs) for people in contracted assisted living facilities who need skilled nursing facility care. PFFS plans may or may not have a provider network, but they cover any provider who accepts Medicare. MSA plans combine a high-deductible health plan with a special savings account. MSA plans don't include prescription drug coverage, but you can enroll in a standalone plan separately.

When comparing the costs of different Medicare Advantage plans, it is important to compare monthly plan premiums and out-of-pocket costs. Monthly plan premiums are consistent, while out-of-pocket costs like deductibles, copays, and coinsurance can be tricky to calculate. Coinsurance is when the cost is split between the plan and the insured person. Plans with low premiums may have high out-of-pocket costs and vice versa.

UnitedHealthcare is committed to helping you find the right plan through its Right Plan Promise. You can enter your ZIP code and specify your requirements, such as included dental coverage, extra benefits, or low monthly premiums.

United Healthcare and Duke Health contract negotiations

UnitedHealthcare is the health insurance offered by many employers in North Carolina. Duke Health is a major health provider in the state, with unmatched quality and expertise in the region.

UnitedHealthcare and Duke Health have been in contract negotiations for some time, with a deadlock being reached in September 2024. This was due to UnitedHealthcare's Community Plan no longer being accepted by Duke doctors, clinics, or hospitals. The Community Plan is a Medicaid plan, and patients with this insurance were forced to switch to a different North Carolina health system. However, patients with certain high-level care needs, such as pregnancy and cancer treatments, could continue receiving services at Duke for 90 days following the agreement's expiration, until January 12, 2023.

Duke Health has stated that they are committed to working with UnitedHealthcare in good faith and hope to reach a new, responsible contract that puts patients first. They urge patients to contact UnitedHealthcare and advocate for continued access to Duke Health services. Duke Health has also been working to reach a new agreement with UnitedHealthcare to protect patients' in-network access to their services, which could be lost as early as October 31, 2024, if a deal is not reached.

UnitedHealthcare and Duke Health have had an ongoing relationship, with Duke being considered "in-network" for UnitedHealthcare Compass in the Triangle area of North Carolina. This relationship has been in place since at least 2015, with some patients expressing concern about losing access to Duke Medicine if they had already chosen a different plan.

Despite the previous contract expiration in 2022 and ongoing negotiations, it appears that UnitedHealthcare and Duke Health have since reached a new agreement. A Reddit user posted in September 2024 that Duke had signed a new contract with UnitedHealthcare, ensuring continued coverage for the next few years.

United Healthcare and Duke Health deadlock

Duke Health and United Healthcare were in a deadlock over contract negotiations, with United Healthcare threatening to remove Duke Health hospitals and providers from its network. This would have resulted in limited access and choice for patients in the Triangle area (Durham, Wake, Orange, and Granville Counties), increased travel time and distance to receive specialized care, and the loss of in-network access to Duke Health's nationally ranked specialties.

United Healthcare claimed that Duke Health was one of the most expensive health systems in the southeast, which Duke Health refuted, stating that they are a low-cost health system. In addition, United Healthcare had not provided Duke physicians with a payment increase since 2019, despite continuing to post record profits.

The deadlock caused concern and distress for patients, some of whom had surgery scheduled and cancer treatment at Duke Health. Many patients shared their frustration and anger online, with some even blaming both parties for the situation.

However, in September 2024, Duke Health announced that they had come to an agreement with United Healthcare, and patients would continue to have in-network access to Duke Health services. This agreement is set to last for a few years, providing relief to those who rely on both providers.

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