Trap patients in NC insurer-hospital fights

North Carolina patients are getting trapped in contract fights between big hospital systems and insurers that decide whether a doctor or hospital stays in network. (theassemblync.com) The Assembly reported that these disputes are becoming more common as health systems get larger and negotiations increasingly turn on reimbursement rates, prior authorization, and denied claims. (theassemblync.com) In North Carolina, recent flashpoints have included Duke Health’s 2024 negotiations with Aetna over the State Health Plan and a separate 2024 standoff with UnitedHealthcare. Duke said that UnitedHealthcare dispute put 172,000 patients at risk of losing in-network access. (theassemblync.com) (corporate.dukehealth.org) The pattern continued in 2025, when WakeMed and UnitedHealthcare split and WakeMed hospitals, outpatient sites, urgent care centers, and specialty practices moved out of network for many UnitedHealthcare members on November 15. (uhc.com) (wakemed.org) UNC Health also spent months in a contract dispute with Cigna in 2025. WRAL reported that when the contract expired on November 30, Cigna members faced higher out-of-network bills or the prospect of changing providers. (wral.com) These fights do not hit every patient the same way. North Carolina law gives continuity-of-care protections to some people with an “ongoing special condition,” including serious acute illness, pregnancy, terminal illness, or care scheduled for surgery or other procedures. (law.justia.com) (house.ncleg.gov) But those protections are limited, and The Assembly found that many patients still end up scrambling over referrals, authorizations, and follow-up care when a contract lapses or a provider leaves a network. (theassemblync.com) Providers say insurers are using denials and prior authorization more aggressively. Duke, in its 2024 public case against UnitedHealthcare, said the insurer had an “excessively high claims denial rate” and had not given Duke physicians a payment increase since 2019. (corporate.dukehealth.org) Insurers answer that hospital systems are demanding rate hikes that would raise premiums and out-of-pocket costs for employers and patients. UnitedHealthcare said WakeMed refused to back off “unreasonable rate increases,” and Cigna said UNC Health’s demands would increase costs for customers. (uhc.com) (axios.com) The result is that a business negotiation over reimbursement can turn into a medical problem for people in chemotherapy, pregnancy care, specialty treatment, or post-diagnosis follow-up. North Carolina has rules meant to cushion that blow, but repeated contract brinkmanship is testing how much protection those rules really provide. (theassemblync.com) (law.justia.com)