How a fight between insurer, Cape Fear Valley leaves Cumberland, Harnett patients in limbo

More than 17,000 patients in the Cape Fear Valley Health System are affected by a major insurer no longer offering in-network coverage for hospital services, according to Health System officials.

Patients affected are insured by the UnitedHealthcare Medicare Advantage plan, according to Chaka Jordan, a system spokesperson. The change means the patients would be responsible for the costs of their hospital care — which for many would be unaffordable.

The health system posted a message on its Facebook page July 26 that said the system’s hospitals, which include the main campus on Owen Drive in Fayetteville and Harnett Health facilities, would transition to out-of-network status for those plans. The change affected only the UnitedHealthcare Medicare plans, the post emphasized.

“Cape Fear Valley Health is still ‘in network’ with all other carriers for managed Medicare plans operating in our region for all aspects of care,” the post said.

The statement continued: “We want to reassure our patients with UnitedHealthcare Medicare plans that there is currently NO CHANGE in their ability to visit their Cape Fear Valley Health physician’s office, access outpatient pharmacy services or utilize Cape Fear Valley and Harnett Health hospitals’ Emergency Departments for emergency care. These visits will still be ‘in-network’ on their plan. The change will solely affect non-emergency hospital services.”

The health system also provided a hotline, 910-615-2222, for people to call with questions and concerns and an email address for its Payer Relations team at CFVUHCIssues@capefearvalley.com.

Jordan said the health system has begun notifying affected patients about the change.

Hardships

The change was a surprise to many patients who were caught off guard and have taken their complaints to NextDoor and other social media sites.

Cheryl Thomas, a retired lawyer, said she helped a friend, a former client of hers, whose doctor informed her the afternoon before a scheduled knee replacement surgery that it was not covered by her insurance. The woman could not afford to go forward with the procedure, Thomas said.

“She is in terrible pain,” Thomas said. “She is on disability. She called me the night before, hysterical.”

Thomas got on the phone and talked with officials with Cape Fear Valley and representatives with UnitedHealthcare.

Thomas places blame on the insurer; she says UnitedHealthcare should cover hospital visits in a Medicare plan.

“I have no issue with the hospital system,” she says. “They’re not the bad guys here.”

A UnitedHealthcare representative recommended her friend schedule the procedure at a UNC Hospital system facility in Lumberton, Thomas says.

She said a woman she spoke to on the Cape Fear Valley hotline was very helpful. She says she was told the hospital is not canceling surgeries in cases like her friends, and it would cover the cost. The procedure was rescheduled for next week.

“They took care of her,” Thomas said.

Contract dispute

The change in coverage relates to a contract dispute between UnitedHealthcare and Cape Fear Valley. The contract between the two entities has expired and negotiations continue, according to the health system.

A statement from UnitedHealthcare, which is based in Minnesota, said the two entities had successfully negotiated and reached a new agreement “less than a year ago.”

The statement continued: “Cape Fear Valley Health chose to end our hospital contract for our Medicare Advantage plan. 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. We remain committed to continued discussions should Cape Fear join us at the negotiating table with a realistic proposal. However, our focus at this time is ensuring North Carolina seniors have access to the care they need through either continuity of care or a smooth transition to a new provider.”

UnitedHealthcare said its Medicare Advantage members will continue to have access to more than a dozen area hospitals, including FirstHealth Moore Regional Hospital; Central Carolina Hospital in Sanford; Rex Hospital in Robeson County; Columbus Regional Healthcare System; Scotland Memorial Hospital; and WakeMed Raleigh campus.

The insurer added that Cape Fear proposed it make exemptions in the contract “that are not compliant as a Medicare Advantage plan with federal regulatory requirements."

As part of its July 26 statement, Cape Fear Valley said: “We want you to know that Cape Fear Valley Health is not asking UnitedHealthcare for a rate increase. We do expect UnitedHealthcare to pay for the services our doctors deem necessary for patients and not unfairly deny our claims.”

Last year, UnitedHealthcare clashed with WakeMed, a triangle-based hospital system that the insurer said was trying to dramatically raise rates in a new contract, according to the Raleigh News & Observer. WakeMed countered that the disagreement stemmed from UnitedHealthcare declining to reimburse it for the cost of procedures at a rate five times higher than other major insurers like Aetna and Blue Cross Blue Shield, the newspaper reported.

The dispute took more than four months to resolve before the parties signed a new three-year agreement in November, according to the News & Observer.

More than 17,000

Jordan said the 17,000 affected patients in Cape Fear Valley Health System’s records do not represent all the people who might be affected. She said some procedures that had been scheduled and approved before the out-of-network change were able to be rescheduled.

“There are assuredly more than that in our market, but they are not in our records because they are not a current patient,” she said. “We continue to hope that Cape Fear Valley Health and UnitedHealthcare will come to an agreement in the future.

Note: An earlier version of this story contained incorrect information about UnitedHealthcare's response. The insurer responded Thursday afternoon with a statement.

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

This article originally appeared on The Fayetteville Observer: Why thousands in Cumberland are stuck in insurer, Cape Fear Valley fight