Below are some frequently asked questions about health insurance options available in 2017.
In the Triangle area, Duke is considered in-network for Blue Local with Duke Health and WakeMed from Blue Cross Blue Shield of North Carolina. Outside of the Triangle, Duke is considered in-network for Blue Select and Blue Advantage, depending on what county you live in. Policies are available based on your county of residence.
If you have questions about the types of plans, costs, or access to non-Duke doctors or hospitals, you should contact the insurance company directly.
If you enrolled in Coventry One or United Healthcare Compass for 2016, you need to enroll in a plan for 2017 that includes Duke Health (Blue Local, Blue Advantage or Blue Select) to ensure you can continue to see your Duke doctor.
The Blue Local, Blue Select and Blue Advantage plans from Blue Cross Blue Shield of North Carolina give you access to a breadth of services offered by Duke Health as well as access to local providers and hospitals. Check with the insurance provider to see which local providers are considered in-network.
If Duke is considered an “out-of-network provider” in your plan, you may have to pay significantly higher out-of-pocket expenses to see a Duke doctor or use a Duke hospital or clinic. To have more control over the cost of your care at Duke, be sure to choose the Blue Local with Duke Health and Wake Med plan from Blue Cross Blue Shield of North Carolina (in the Triangle) or Blue Select or Blue Advantage (outside the Triangle).
If you have already chosen a plan but now are concerned your access to Duke Health may be limited, you must change your plan before January 31, 2017 by visiting HealthCare.gov. In the Triangle area Duke is ONLY participating in Blue Local with Duke Health and WakeMed from Blue Cross Blue Shield of North Carolina. Outside of the Triangle, Duke is considered in-network for Blue Select and Blue Advantage in most North Carolina counties. No insurance plan changes can be made between January 31, 2017 and the next open enrollment period, unless you have a qualifying life event.
If your care needs to be transitioned to another hospital or specialist, we will work with your covered provider to appropriately transition your care and medical records.
The insurance website may not be as current as Duke's information. The information we supply will let you know if the insurance plan you are choosing considers Duke to be an in-network provider.
There are a few resources to help you choose the right plan for you and answer any questions you may have:
Coventry Healthcare – Advantra
Gateway Health Plan
Humana Medicare PPO
Serious illness or accidents can occur without notice and can require more advanced care than what your community hospital offers. For the ultimate peace of mind, you’ll want to keep your local providers plus have access to specialists at a larger health system like Duke.
If a medical emergency arises, call 911 or go to the closest hospital to you. In the case of emergency care, your insurance company is required to have the same benefits and same patient cost-sharing no matter what emergency room you go to. In other words, you can expect the same co-pays and deductibles as you would for in-network care.