For Duke and UNC Health patients, what does it mean to be out-of-network?
AI-generated summary reviewed by our newsroom.
- UNC Health and Cigna, Duke Health and Aetna remain in contract disputes.
- Out-of-network care leads to higher patient bills and increased cost-sharing.
- Emergency services will retain in-network coverage despite insurer disputes.
Duke and UNC Health remain at odds with a pair of major insurance companies, meaning patients across the Triangle could find themselves out-of-network if an agreement on a contract can’t be reached before the fall deadline.
Duke and Aetna are still in dispute, as are UNC and Cigna.
But what does it mean to be “out-of-network?” How would this affect patients?
Higher Costs
As Cigna explains it, doctors, hospitals and pharmacies that are “in network” agree to a discounted rate for services that are covered. An “out-of-network” doctor can charge a higher, full price that the insurer can’t control.
So if an out-of-network doctor charges more than an insurance plan will pay, the patient pays the difference.
If Cigna and UNC can’t reach a “new and fair” agreement, all UNC Health providers would go out-of-network, said spokesman Alan Wolf. The same would go for Duke and Aetna.
Every insurance plan is different, Wolf said, but generally insurers will cover a smaller percentage of the bill for out-of-network care than they would for in-network services, meaning the patient would pay a larger portion of the bill.
“UNC Health takes very seriously the potential disruption this may cause our patients,” Wolf said Wednesday, “and we are doing everything in our power to avoid that outcome. We will work closely with our patients to ensure they continue receiving ongoing care.”
Different deductibles
As Aetna explains it, out-of-network physicians charge more than the amount the company allows. Network health care providers agree not to engage in this practice, called “balance billing.”
Patients who go out-of-network are hit harder because the amount they pay for “balance billing” does not count toward their deductible, Aetna says, nor does it go toward a cap on the total they might pay.
Insurers often keep a separate deductible just for these types of costs, and they are usually higher.
What about emergency care?
Aetna says it will treat emergency care as an in-network service even when it is not.
This story was originally published September 17, 2025 at 2:23 PM.