25,000 in Cumberland, Harnett still in limbo as Cape Fear Valley Health, insurer stop talking

Thousands of patients with UnitedHealthcare Medicare Advantage remain without hospital care coverage as a dispute between Cape Fear Valley Health System and UnitedHealthcare continues. The two sides recently broke off contract negotiations altogether, and a hospital spokeswoman said last Thursday the system does not envision a new agreement in the near future.

The old contract between UnitedHealthcare and Cape Fear Valley expired in late July. At the time, the health system estimated 17,000 Medicare Advantage customers in Cumberland and Harnett counties were affected.

“We have since also heard from local insurance agents who estimate there are at least 25,000 people enrolled in this program in the region,” said Chaka Jordan, a health system spokesperson.

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Chad Blanton, an independent insurance broker with The Assurance Group, said he had fielded numerous calls, from his own clients and other people who were worried or looking for information. He has told some people they will not be affected because they receive hospital care somewhere other than Cape Fear Valley Medical Center or another health system hospital. The contract ending does not affect services such as clinic care.

“One piece of advice: If you don’t use Cape Fear Valley (hospital), it’s not really that big a deal,” he said. “There’s a lot of people who use FirstHealth, or maybe if they live in Hope Mills, they may go to Lumberton. I have clients who live out in Dunn, Eastover.”

Blanton said “the biggest problem" is that many people did not receive the letter announcing the change.

“United sent out something to people to let them know, but not everybody got it," he said. "There’s a lot of people kind of left out to hang, and they didn’t know what to do.”

He said each client’s situation is different and they would have to determine whether to stick with United Healthcare Medicare Advantage despite the loss of some coverage — or shop elsewhere.

He noted one potential snag for people who may seek out a different Medicare plan: “With Medicare, you can’t just sign up for it today and get it tomorrow. Whenever you do it, it’s going to the first of the following month.”E

A person could wind up in a “tough situation for a month” if they’re not careful, he said.

What sunk negotiations

The hospital system and UnitedHealthcare have different versions of what sank negotiations. Both parties appeared to leave the door open for further negotiations at a future date — but the hospital system sounded like it would not happen any time soon.

“Despite successfully negotiating and reaching agreement on a new multi-year contract less than a year ago, Cape Fear Valley Health chose to end our hospital contract for our Medicare Advantage plan,” said Cole Manbeck, a spokesperson for UnitedHealthcare. “Cape Fear delivered two unreasonable proposals as a condition of continuing our relationship, including demands that would make its hospitals 15% higher cost than any hospital in our Medicare Advantage network in North Carolina.”

The hospital system rebuffed “multiple attempts to compromise and to find a middle ground,” according to UnitedHealthcare.

“We remain committed to continued discussions should Cape Fear join us at the negotiating table with a realistic proposal,” Manbeck said.

Jordan from the Cape Fear system said in a statement the dispute that led to the contract’s termination was not about rates.

“It was about UnitedHealthcare’s clinical policies that we believe attempt to improperly interfere with physicians’ medical decision-making,” she said, “and UnitedHealthcare’s processes that deny payment for care that we believe is medically necessary.”

She said the system did not anticipate that its hospitals would rejoin the Medicare Advantage network “any time soon.

“But we continue to hope that Cape Fear Valley Health and UnitedHealthcare will come to an agreement in the future on this issue,” she said.

What is not affected

Manbeck with UnitedHealthcare said the contract ending does not impact doctors employed by Cape Fear Valley Health because they are on a separate contract and continue to remain in the Medicare Advantage network.

Also not affected, according to UnitedHealthcare:

— Commercial or Medicaid contracts with Cape Fear Valley Health.

— People enrolled in employer-sponsored, individual and UnitedHealthcare Medicaid plans.

“People enrolled in our Group Retiree PPO plan may still receive care from a Cape Fear Valley Health hospital so long as they are a Medicare-approved provider that accepts the plan,” UnitedHealthcare said in a press release. “Their share of the cost will be the same as if they were part of the network.”

UnitedHealthcare Group Retiree members were encouraged “to speak with Cape Fear to confirm they’ll continue to provide care for them in their hospitals, regardless of their network status,”

For more information, members can visit medicare.uhc.com/retiree.

Other hospitals in the region

UnitedHealthcare provided a list of hospitals where Medicare Advantage customers could receive care.

“Members who have questions about alternative hospitals in their area should call the number on their health plan ID card,” a spokesperson said.

On the list, which the insurer noted is not comprehensive, are:

— Central Carolina Hospital in Sanford.

— Columbus Regional Healthcare System in Whiteville.

— Duke Raleigh Hospital in Raleigh.

— First Health Moore Regional Hospital in Pinehurst.

— First Health Richmond Memorial Hospital in Rockingham.

— UNC Health Johnston in Smithfield.

— Pender Memorial Hospital in Burgaw.

— UNC Rex Hospital in Raleigh.

— Sampson Regional Medical Center in Clinton.

·— Scotland Memorial Hospital in Laurinburg.

— Southeastern Regional Medical Center in Lumberton.

— WakeMed Raleigh Campus

— Wayne Memorial Hospital in Goldsboro.

— Wilson Medical Center in Wilson.

“UnitedHealthcare members should always go to the nearest hospital in the event of an emergency,” a spokesperson said. “Their services will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.”

Cape Fear Valley: More options

Jordan said UnitedHealthcare Medicare Advantage members can apply for continued access to Cape Fear Valley hospitals by calling the number on the back of their insurance card.

“Otherwise, UnitedHealthcare may direct members to receive services at hospitals outside our service area,” she said.

She said that Cape Fear Valley emergency departments, ExpressCares, doctors’ offices and pharmacies remain available on an in-network basis.

Jordan said the next open enrollment window for insurance coverage begins Oct. 15, when patients can choose a different Medicare Advantage plan that would begin January 1 of next year.

“During open enrollment, patients can also choose to return to the original government-managed Medicare program,” she said.

Myron B. Pitts can be reached at mpitts@fayobserver.com or 910-486-3559.

Note: A previous version of this story shared an anecdote that included inaccurate information about ER care for UnitedHealthcare Medicare Advantage patients. It has been removed.

This article originally appeared on The Fayetteville Observer: 25,000 in Cumberland, Harnett affected as Cape Fear Valley ends talks with insurer