UnitedHealthcare Faces Out-of-Network Charges at ECU Health Facilities

UnitedHealthcare policyholders will now encounter out-of-network charges for most services at ECU Health facilities following the termination of a contract between the insurer and the healthcare provider. The breakdown in negotiations over long-term reimbursement rates prompted the expiration of the agreement. While out-of-network fees will apply, emergency services at ECU Health will still receive reimbursement at in-network rates, and select ECU Health-affiliated practices will remain in-network until February 15, 2027.

UnitedHealthcare reported offering substantial rate increases on April 28 to exceed market averages, aiming to restart negotiations and keep ECU Health accessible to its members. However, these efforts were allegedly rejected by ECU Health, which, according to UnitedHealthcare, demanded even greater price increases. ECU Health spokesperson Brian Wudkwych stated that despite good faith efforts, the negotiations did not align with the financial realities faced by healthcare providers in eastern North Carolina.

The two parties continue to dispute reimbursement structures, with UnitedHealthcare alleging ECU Health's proposed rates would exceed statewide academic medical center averages by 2028. Proposals for Medicaid and Medicare Advantage plans were described as some of the highest cost options. ECU Health counters that any further reduction in reimbursement could hinder its ability to deliver services due to escalating operational costs and labor shortages. Both organizations are currently working to ensure ongoing care options for UnitedHealthcare members, although no new negotiations are scheduled at this time.