Wakemed (NC)

WakeMed is demanding price hikes of nearly 40%

We are working to keep costs affordable for families and employers in North Carolina

We are attempting to negotiate with WakeMed to renew our network relationship. Our goal is to reach an agreement that is affordable for North Carolinians and local employers while maintaining continued, uninterrupted network access to WakeMed.

Unfortunately, despite our repeated efforts to engage in good-faith discussions, WakeMed has continued to stall and delay our negotiation, just as they have done in negotiations with multiple health plans over the past few years.

With only two weeks before our contract is set to expire on Nov. 15, WakeMed delivered its first comprehensive proposal in the entirety of our negotiation. Instead of working toward a compromise North Carolina families can afford, WakeMed is demanding unsustainable price hikes of nearly 40%, including a 30% increase in just the first year of our contract. WakeMed’s proposal would increase health care costs for consumers and employers by more than $94 million over two years. 

In the event we are unable to reach an agreement, WakeMed’s facilities and specialty providers in the Raleigh region will be out of network for people enrolled in the following plans, effective Nov. 15, 2025:

  • Employer-sponsored and individual commercial plans
  • Medicare Advantage plans, including Group Retiree, and Dual Special Needs Plan (DSNP) 

Primary care physicians employed by WakeMed are not impacted by this negotiation and will remain in-network, regardless of the outcome of our negotiation.

People enrolled in our Medicaid plans are not impacted. They will continue to have network access to WakeMed on and after Nov. 15. This does not impact Medicare Supplement plans. People enrolled in a Medicare Supplement plan can continue accessing care with WakeMed on and after Nov. 15, 2025.

WakeMed is demanding unsustainable price hikes of nearly 40%, including a 30% increase in just the first year of our contract

WakeMed’s proposal would increase health care costs for consumers and employers in North Carolina by more than $94 million over two years.

Excessive rate increases drive up overall health care costs, directly resulting in a financial strain for the people we serve.

Agreeing to WakeMed’s proposal would also significantly drive-up premiums and out-of-pocket costs for consumers, as well as the cost of doing business for employers, impacting their ability to offer affordable health care coverage for their employees.

We are proposing market-competitive rates that will continue to reimburse WakeMed consistent with its peers in the market while slowing the unsustainable rise in health care costs.

We are asking WakeMed to join us at the negotiating table and work toward an agreement.

WakeMed’s demands for a 30% price hike in just the first year of our contract would make it the most expensive health system in the Raleigh market by 2026

WakeMed’s proposal would make its hospitals 25% higher than the average cost of all other hospitals in the Raleigh area, which includes academic health systems such as Duke Health and UNC Health.

WakeMed’s physicians would be nearly 35% more expensive than the average cost of other physicians in our network in Wake, Orange, and Durham counties.

WakeMed’s proposed price hikes would significantly drive up the cost of many common services and procedures at WakeMed

To help illustrate the impact of WakeMed’s proposal, consider the following examples:

  • A typical inpatient surgery would cost nearly $10,500 more than that same surgery costs today
  • The average cost of an ER visit would increase by more than $1,000
  • An obstetrics/labor & delivery admission would cost over $4,700 more than it does today
  • WakeMed would charge an additional $1,150 for a typical MRI and $825 more for a CT scan
  • A common outpatient surgery would cost nearly $3,900 more

 

Employers in North Carolina would bear the brunt of WakeMed’s price hike demands

Our self-funded employer group customers have charged us with the responsibility of providing their employees access to quality, affordable health care.

We pass any savings from negotiating more competitive rates directly to our self-funded customers, which they could in turn use to hold premiums steady for employees or to lower them in some cases.

More than 70% of our employer-sponsored members in North Carolina are enrolled in self-funded plans, which means that these employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims.

As the prices for health care continue to rise, employers have less money available to help grow the business through things like investments in new technologies or salary increases for hard-working employees.

WakeMed’s pattern of delay and misinformation

WakeMed has continued to stall and delay the negotiation

We have attempted to engage in good-faith discussions with WakeMed with the goal of reaching an agreement.

We delivered a proposal on July 21 that included market-competitive rates. WakeMed then spent the next three months only engaging in limited discussions and refused to provide a comprehensive proposal.

WakeMed finally sent us its first complete proposal on Oct. 30, only two weeks before the contract is set to expire on Nov. 15.

This behavior is nothing new for WakeMed, which repeatedly puts its patients in the middle of public disputes

WakeMed is employing the same playbook tactic that it deployed during our last negotiation in 2022 and with three other large health plans over the past two years:

The pattern is clear, and there is one common denominator – WakeMed. It is evident by the health system’s past behavior that it is not focused on what’s best for North Carolina businesses or their employees.

Instead, WakeMed continues to deploy a playbook that includes delaying negotiation efforts while using its patients as leverage, presumably in an effort to obtain exactly what the health system wants. 

WakeMed’s allegations around denials are not true

These false claims are nothing more than a distraction from our goal of reaching an agreement that is affordable for consumers and employers.

In fact, WakeMed’s experience is consistent with claims approvals data we've reported publicly: Get the facts: How many claims are denied?.

At UnitedHealthcare, we approve and pay 90% of claims shortly after they’re submitted. The remaining 10% go through an additional review process.

We verify the patient is a UnitedHealthcare member, check for duplicate claims, confirm that the physician has submitted the necessary clinical documentation, ensure the service is a covered benefit, and assess whether the service aligns with the most up-to-date, evidence-based clinical guidelines.

After this additional review process is completed, UnitedHealthcare’s claims approval rate stands at 98% for claims for eligible members, when submitted in a timely manner with complete information, and after duplicate claims are removed.

The majority of WakeMed’s claims that are not approved are duplicate submissions, where the provider submitted the same claim more than once, claims missing required information, and claims where the patient isn’t even a UnitedHealthcare member.

These false accusations are yet another common playbook tactic by WakeMed. The health system has made similar allegations against other large payers in North Carolina regarding claims denials over the past two years.

The fact is that a vast majority of WakeMed’s claims were approved and paid timely. Out of those that were not approved, the majority were preventable and would have otherwise been approved if not for an issue in WakeMed’s internal processes.

We continue to offer to assist and collaborate with WakeMed in helping them improve its administrative processes.

WakeMed has demonstrated a pattern of making false, inflammatory accusations

WakeMed has falsely stated that our rates have not kept up with the rising costs of healthcare. WakeMed has received meaningful rate increases annually over the past several years.

Based on WakeMed’s own self-reporting in 2024, its hospital margin on UnitedHealthcare commercial plans was 47%, which means that we are currently paying WakeMed nearly double their costs. Yet WakeMed is still demanding additional rate increases of nearly 40%. 

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