ECU Health
ECU Health refuses to extend agreement; some providers now out of network as of April 29
We delivered a proposal to ECU Health on April 28 that included meaningful rate increases that would continue to reimburse the health system above market averages.
We also proposed to ECU Health that we extend our agreements for those providers whose contracts were set to expire on April 29. This would have allowed additional time for our organizations to negotiate while maintaining continued access to the health system for the North Carolinians we serve. ECU Health refused, presumably to use its patients as leverage to pressure us to agree to the significant price hikes it is seeking.
As a result, ECU Health’s hospitals, facilities and Vidant Medical Group physicians are out of network for UnitedHealthcare Community Plan (Medicaid), as of April 29. However, people enrolled in our Medicaid plan can continue to receive care at any ECU Health provider or facility despite leaving our network. We will reimburse ECU Health for the services provided. Please confirm with your ECU Health provider that they will continue to see you on and after April 29.
Additionally, Vidant Medical Group physicians are out of network for employer-sponsored commercial plans, Individual Family Plan (IFP) and Medicare Advantage plans, including Dual Special Needs Plan (DSNP) and Group Retiree plans, effective April 29.
Despite ECU Health choosing for some of its providers to leave our network, our goal remains the same—to reach an agreement that provides North Carolina families access to affordable care.
We have a longstanding relationship with ECU Health. UnitedHealthcare and the UnitedHealth Foundation (UHF) have provided ECU Health multiple grants over the past few years as part of our collaborative efforts to improve the health and well-being of the people we serve throughout eastern North Carolina.
We want people to have continued access to ECU Health. However, we also have a responsibility to ensure that access is affordable. Health care costs are directly affected by the reimbursement we negotiate with health systems in our network. One of the leading drivers of rising health care costs are the prices hospitals charge, such as ECU Health.
Our goal during this negotiation is to reach a solution that continues to reimburse ECU Health appropriately so they can continue providing the quality care people rely on while not placing a burden on hard-working families and employers already struggling during challenging economic times.
Throughout our discussions, we have unsuccessfully attempted to get meaningful engagement from ECU Health leadership, only to continually be referred to an outside consultant who is negotiating on the health system’s behalf. We met with ECU Health’s consultant on April 29 to discuss our latest proposal as part of our efforts to move our negotiation forward. We were informed they would not be responding to our proposal and proceeded to cancel future meetings pertaining to our negotiation.
ECU Health’s latest proposal includes demands for a 34% price hike for our employer-sponsored commercial plans that is not affordable for North Carolinians or employers. ECU Medical Center would be approximately 40% higher than the average cost of all other academic medical centers in North Carolina by 2028 if we agreed to this.
The health system is seeking significant rate increases for our Medicaid plan that would make them the most expensive in all of North Carolina. They are also demanding substantial price hikes for our Medicare Advantage plans that would make them among the highest cost in the state.
As we continue our discussions, we want to remind you of the following:
The first day out of network for ECU Health’s providers varies by the provider type and benefit plan as follows:
- UnitedHealthcare Community Plan (Medicaid) of North Carolina:
- April 29, 2026 — ECU Health hospitals and facilities as well as Vidant Medical Group physicians
- Feb. 15, 2027 — ECU Physicians
- UnitedHealthcare employer-sponsored commercial plans, including UMR and Surest, as well as Medicare Advantage plans, including Dual Special Needs Plan (D-SNP) and Group Retiree, and Individual Family Plan (IFP):
- April 29, 2026 — Vidant Medical Group physicians
- July 15, 2026 — ECU Health hospitals
- Nov. 1, 2026 — Kinston Medical Endoscopy
- Feb. 15, 2027 — ECU Physicians
Any individual in the middle of treatment for a serious or complex condition with an ECU Health provider at the time they went out of network may be eligible for continuity of care
Continuity of care provides continued in-network benefits for a specified period of time after a hospital or physician leaves our network. A few examples of patients who may qualify include:
- Women who are pregnant;
- Patients with newly diagnosed or relapsed cancer, or those currently in active cancer treatment.
UnitedHealthcare members who have questions about continuity of care should call the number on their health plan ID card.
UnitedHealthcare members continue to have access to a large network of providers.
- UnitedHealthcare members should call the number on their health plan ID card if they need assistance finding another provider. They can also use the provider directory on our member website to search for alternative hospitals and doctors.
We want to reassure you we are doing everything we can to reach an agreement and will remain at the negotiating table as long as it takes to renew our relationship. However, we need ECU Health to share in our commitment of reaching an agreement that’s affordable for North Carolina families and employers.
ECU Health issued a notice to end our contract and is now demanding a 34% price hike that would make it higher cost than any health system in our commercial network in North Carolina
ECU Health has acquired providers over the years and become the market-dominant health system in eastern North Carolina, giving it significant influence over local health care costs.
The reimbursement ECU Health receives today is significantly higher than the average of all other health systems in our network in the state, and higher than the average reimbursement other peer academic health systems in North Carolina receive.
ECU Health is now using its market power presumably as leverage to pressure us to agree to significant price hikes that would drive up health care costs for people and employers throughout eastern North Carolina.
ECU Medical Center would be approximately 40% higher than the average cost at all other academic medical centers in North Carolina by 2028 if we agreed to ECU Health’s demands
Agreeing to ECU Health’s proposed price hikes would mean it would cost approximately $18,000 more to deliver a baby at ECU Medical Center by 2028 compared to the average cost of all other academic medical centers in North Carolina. This would turn childbirth into a luxury service rather than a community benefit.
Common services like an MRI would cost $2,100 more than the average cost of all other academic medical centers in the state, while a CT scan would be $2,000 more. This is particularly impactful given people often need more than one of these scans, further compounding what they pay for these services.
ECU Health issued a notice to end our Medicare and Medicaid agreements with demands for significant rate increases for both plans, despite previously communicating these contracts were not an issue for the health system
We presume ECU Health took this step to use some of its most vulnerable patients as leverage to obtain the significant rate increases it is seeking for our commercial plans.
However, the health system is now proposing significant rate increases for both plans. Agreeing to this would make them among the most expensive in our Medicare Advantage network in North Carolina and would have a direct impact on the benefits the people we serve rely on.
The price hikes ECU Health is seeking for our Medicaid plans would make it the highest cost health system in our Medicaid network in the state. The states where we operate our Medicaid plans have asked us to support their efforts to provide quality health care coverage to their residents while also helping to contain rapidly rising health care costs. We take this responsibility seriously and are committed to being a good steward of taxpayer dollars.
Nearly 90% of ECU Health’s proposed price hikes for our commercial plans would be paid out of the budgets of self-insured employers
Most North Carolinians are enrolled in employer-sponsored commercial plans that are self-funded. That means the actual cost of health care services is directly paid by these employers, their employees, and their families, while we manage the administrative tasks on their behalf.
When hospitals demand steep price hikes, employers must make difficult decisions about benefits and costs. When provider costs rise, these employers bear the financial risk and often have no other choice than to pass those costs along to employees, resulting in higher deductibles, out-of-pocket expenses, and employee contributions.
Agreeing to ECU Health’s near 60% price hike demands would mean eight employers would see their health care costs increase by $1 million or more each over the next three years. One business would experience an approximate $7.8 million increase, while three other companies would see their costs rise between $4.1 million to $6.2 million.
As the prices for health care continue to rise, these employers have less money available to help grow their business through things like investments in new technologies or increase salaries for employees.