“The burdensome payment policies, denials and reimbursement delays for patient care have made it financially and operationally unsustainable for the hospital to continue participation in these plans……”
Financially and operationally unsustainable’: North Carolina hospital to drop Blue Cross Blue Shield, UnitedHealthcare Medicare Advantage plans
By:Alan Condon
CarolinaEast Medical Center, a 350-bed hospital in New Bern, N.C., will drop Blue Cross Blue Shield and UnitedHealthcare Medicare Advantage plans, effective July 1, citing burdensome payment policies, claim denials and reimbursement delays.
The hospital issued termination notices to both insurers, but negotiations with UnitedHealthcare remain ongoing, a spokesperson for CarolinaEast Health System confirmed to Becker’s.
The decision applies only to the hospital facility. Physician practices within CarolinaEast Physicians will remain in-network with both plans. Patients enrolled in original Medicare are not affected.
“This was a difficult decision. However, over time, the burdensome payment policies, denials and reimbursement delays for patient care have made it financially and operationally unsustainable for the hospital to continue participation in these plans,” CarolinaEast said in a statement.
After July 1, CarolinaEast Medical Center will still accept patients covered by both plans, but certain non-emergency services may be subject to out-of-network cost-sharing.
UnitedHealthcare said it is working to preserve access for its members.
“CarolinaEast has indicated it is seeking to exit Medicare Advantage plans, a move that would impact people who depend on these plans for added benefits and cost savings compared to a traditional Medicare plan,” a spokesperson for the insurer said in a statement provided to Becker’s. “We are actively engaged in discussions with CarolinaEast with the goal of reaching an agreement that preserves access to the health system’s hospitals for Medicare Advantage beneficiaries.”
Blue Cross Blue Shield of North Carolina said it is disappointed by the decision but will continue working with CarolinaEast in other areas, including Medicaid.
“Medicare Advantage is an important coverage option for many people in this region and across the state, particularly older adults who rely on coordinated, affordable care close to home,” Blue Cross NC said in a statement. The insurer said it remains open to welcoming the hospital back into its Medicare Advantage network in the future.
CarolinaEast’s move is part of a broader trend of hospitals and health systems pushing back against Medicare Advantage insurers over prior authorization requirements, claim denials and payment delays. Medicare Advantage now covers 55% of eligible Medicare beneficiaries nationwide — more than 35 million people — making network disputes with the program increasingly consequential for patients, providers and payers.
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