A contract dispute between Duke Health and UnitedHealthcare could lead to coverage changes

Duke Health is notifying patients that their coverage could be impacted by a contract dispute with UnitedHealthcare, one of the U.S.'s largest insurers .

Why it matters: If a deal isn't reached by Oct. 31, Duke Health patients with UnitedHealthcare insurance will be considered out of network, meaning most will need to pay more out of pocket or find a new doctor or health system, Duke informed patients in a Monday letter obtained by Axios.

• Around 170,000 Duke Health patients throughout the state could be affected if the UnitedHealthcare contract expires, per Duke Health.

The big picture: This isn't the first time a health system in the Triangle has gone public with its contract negotiations with UnitedHealthcare.

• Last year, UNC Health similawarned patients of potential disruption due to contract negotiations with the insurer but ultimately came to an agreement four days before its contract expired .
• In 2022, WakeMed saw thousands of UnitedHealthcare patients go out of network for months before it signed a new contract .

Zoom in: Duke and UnitedHealthcare have been negotiating since April, according to a UnitedHealthcare spokesperson, and the insurance company sent its fourth proposal to Duke on Tuesday.

What they're saying: Duke Health said in a statement to Axios that it hopes UnitedHealthcare will agree to a new contract that fairly reimburses Duke.

• In its letter, Duke Health said UnitedHealthcare's reimbursements have not kept up with inflation.
• "To continue serving the patients and families who trust us for unmatched quality, expertise and the best possible outcomes, we must ensure that UnitedHealthcare — and all insurance companies we partner with — reimburse Duke Health at fair rates that cover the rising cost of care," the health system said in the statement. "That is why we are negotiating today."

The other side: The UnitedHealthcare spokesperson said its priority is reaching an agreement with Duke Health.

• "We delivered a new proposal on Aug. 20 that includes meaningful rate increases that would ensure Duke continues to be reimbursed similar to peer health systems," UnitedHealthcare spokesperson Cole Manbeck said in a statement.
• "We will remain at the negotiating table as long as it takes to reach an agreement," Manbeck added. "We hope Duke joins us there and works toward a solution that North Carolina families and employers can afford."

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