UnitedHealthcare strives to provide Medicare Advantage (MA) members with access to quality health care by contracting with a broad network of hospitals at affordable rates. Recently, you may have heard that UnitedHealthcare provided Duke LifePoint a comprehensive proposal more than two months ago to begin renewal negotiations.
Here’s what you need to know
- UHC is disappointed with Duke LifePoint’s lack of participation and failure to provide them a proposal or inform them what they are seeking in this negotiation.
- UHC feels strongly that the tenets of their relationship must be rooted in high-quality patient care and collaboration to serve their community.
- If the contracts are not renewed, some Duke LifePoint facilities may be out-of-network December 15, 2018 and January 1, 2019.
- UHC remains committed to working with Duke LifePoint to reach a resolution to continue to provide care to UnitedHealthcare MA members.
If contracts are not renewed, the following facilities may be out-of-network
- Person Memorial Hospital: Dec. 15, 2018
- Central Carolina Hospital: Jan. 1, 2019
- Frye Regional Medical Center: Jan. 1, 2019
- Rutherford Hospital: Jan. 1, 2019
Impacted UnitedHealthcare plans
- AARP® MedicareComplete® Plan 1 H5253-037
- AARP MedicareComplete Plan 1 H5253-080
- AARP MedicareComplete Plan 1 H5253-104
- AARP MedicareComplete Plan 2 H5253-038
- AARP MedicareComplete Plan 2 H5253-079
- AARP MedicareComplete Plan 2 H5253-103
- AARP MedicareComplete Plan 3 H5253-105
- AARP MedicareComplete Plan Essential® H5253-040
- AARP MedicareComplete Choice® H2228-018
- UnitedHealthcare Dual Complete® (HMO SNP) H5253-041
- UnitedHealthcare Dual Complete RP (RPPO SNP) R1548-001
- Duke LifePoint sent letters to affected members the week of Oct. 15, 2018, alerting them to the potential network change.
- UnitedHealthcare has strong relationships with other physicians in the area to ensure members have uninterrupted access to the care they need.
- Should UHC and Duke LifePoint not reach an agreement, members may still be able to use the facilities on an out-of-network basis; however, they will be responsible for their out-of-network cost share. Members should refer to the Evidence of Coverage for details about the specific plan.
Continuity of Care
If the contracts are not renewed, some UnitedHealthcare members may be able to continue receiving care at the affected facilities with in-network coverage for a period of time. These members include, but are not limited to, those who are scheduled for surgery, have terminal illnesses or those undergoing active treatment for a serious medical condition, such as cancer. To determine eligibility, members can call the customer service number on their health plan ID card.
What you can do
If the contracts are not renewed and you receive questions from members, please help them find another UnitedHealthcare in-network provider.