WakeMed says no Medicare deal with United Healthcare, out-of-network status next
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- WakeMed says UnitedHealth stopped Medicare talks, risking out-of-network status.
- WakeMed warns UnitedHealth members could face about 40% higher charges.
- WakeMed urges patients to verify coverage and authorizations after Nov. 15.
WakeMed officials said Tuesday that United Health Care has stopped negotiating days before the deadline for reaching a Medicare deal, an impasse that threatens to place its Medicare Advantage patients “out-of-network” for health care.
In a letter to patients, WakeMed said UHC decided to stop talks on Medicare Advantage before the current contract ends on Nov. 15, meaning all WakeMed hospitals, clinics, specialists and urgent care will lose in-network status on that date.
Patients who seek medical care with out-of-network providers typically pay higher bills. Without a deal, WakeMed estimates UHC health plan members could pay 40% more for services. Medicare Advantage represents about half the volume of overall Medicare patients.
In an email to The N&O, WakeMed spokeswoman Kristin Kelly said UHC is scaling back Medicare Advantage offerings in 109 counties across 16 states, part of a broader strategy in response to government pressure, federal funding cuts and rising health care costs.
She added UHC’s proposals include no increase in reimbursements over the next four years despite rising costs for supplies, equipment and labor.
“UHC seems to have identified the Raleigh/Triangle market as one that is too expensive to operate in and is using WakeMed’s contract as part of its exit strategy,” Kelly wrote. “We remain at the table in good faith with the hope that UHC will join us to come to a fair agreement with a shared commitment to patients. We cannot accept the terms UHC has proposed to date as they put WakeMed at risk for being able to take care of our community and deliver on our mission of caring for all.”
What United Said
United Healthcare presented a different version of events, stressing that Medicare Advantage is not off the table and negotiations continue for employee-sponsored and individual commercial plans.
“WakeMed is demanding a near 40% price hike, including a 30% rate increase in just the first year of our contract. That would make it the most expensive health system in the Raleigh market,” said Laurie Mandell, United Health Care CEO for Carolinas Health Plan.
“WakeMed’s proposal would increase health care costs for North Carolinians and employers by more than $94 million over two years. Our top priority is to reach an agreement, and we are proposing meaningful rate increases that continue to reimburse WakeMed at market-competitive rates. We ask WakeMed to join us at the negotiating table and provide a realistic proposal North Carolina families and employers can afford.”
WakeMed said UHC patients can still use emergency services after Nov. 15, but it urged checking with the insurer for prior authorization for other care.
Meanwhile, Duke Health and Aetna reached a new agreement in October, just over two weeks before their contract was set to expire. The multi-year deal keeps all Duke providers and locations in network for Aetna’s commercial and Medicare Advantage members.
This story was originally published November 11, 2025 at 10:58 PM.