Updated October 8, 2025
We are working to renew our network relationship with WakeMed
We are working to renew our network relationship with WakeMed so our members can continue accessing care at affordable, market-competitive rates. Unfortunately, WakeMed has not yet provided a single comprehensive proposal, even with less than two months left on our current agreement. Instead, WakeMed has stalled discussions and is repeating a pattern of putting North Carolinians in the middle of negotiations while spreading misinformation, as they’ve done with multiple insurers in recent years.
We remain committed to good-faith negotiation with the goal of renewing our relationship. We ask WakeMed to join us at the negotiating table and work toward an agreement.
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.
We continue to attempt to engage in good-faith discussions with WakeMed to reach an agreement.
Our team scheduled several calls and meetings with WakeMed over the past few months. WakeMed consistently canceled these meetings.
We delivered a proposal on July 21 that included market-competitive rates. To date, WakeMed has still not provided a comprehensive proposal throughout the entirety of our negotiation.
WakeMed finally agreed to meet on Aug. 19, less than 90 days before the contract is set to expire. Since then, WakeMed has only engaged in a limited, narrow scope of discussion and refuses to have comprehensive conversations.
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:
- Thousands of North Carolina residents caught in WakeMed-Humana dispute
- 'I feel I have no control': Dispute between Cigna, WakeMed leaves patients in limbo
- WakeMed-Aetna End Long Term Contract
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? | News & articles | UnitedHealthcare.
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.
We will remain at the negotiating table for as long as it takes.
We respect the support and care that WakeMed’s frontline care teams provide for the people we mutually serve.
That is why we will remain at the negotiating table for as long as it takes. However, we need WakeMed’s administrative team to join us there and engage in meaningful discussions.