Health insurance

Does Duke Medicine accept my health insurance plan? This is one of the most common questions we get asked by patients every day. The answer can have an important impact on the decisions you make regarding your care.

Duke Medicine contracts with most major health insurance plans and transplant networks. Before scheduling a hospital or clinic visit, it’s best to check with your health insurance plan to confirm your coverage.

Please call your insurance company and ask if you have access to health care services at Duke Medicine locations, and what (if any) copayments, coinsurances, and deductibles will be your responsibility. The Duke Consultation and Referral Center (888-275-3853) can also help you with insurance-related questions.

Accepted health insurance plans

Aetna 

  • Aetna of the Carolinas Elect Choice (EPO, HMO, QPOS, US Access, Open Access)
  • Aetna of the Carolinas Open Choice (PPO, HMO, QPOS, US Access, Open Access)
  • Aetna of the Carolinas Managed Choice (MC)

BlueCross Blue Shield of North Carolina

  • Blue Advantage
  • Blue Options (123, PPO, HSA)
  • Blue Select
  • Blue Value – Duke Medicine does not participate in this plan

CIGNA

  • Cigna Open Access
  • Cigna Open Access Plus

Coventry Healthcare

  • Coventry Healthcare of the Carolinas
  • Carelink
  • Coventry National Network

Duke Select

  • Duke Basic
  • Duke Select

First Health
Gateway Health Alliance
Halifax Physician-Hospital Organization
Humana – Choice Care Network
MedCost
MultiPlan / Private Healthcare Systems
NC State Employees Health Plan
OneNet PPO
Healthgram
Humana

  • Humana Choice Care (PPO)

MedCost
MultiPlan / Private Healthcare Systems
NC State Employees Health Plan
OneNet PPO
Optima Health

  • Optima Vantage (HMO)
  • Optima Plus (PPO)
  • Optima Family Care (Medicaid HMO in VA)
  • FAMIS
  • Optima Individual & Family (On & Off Exchange Plans)

TricareDuke Primary Care does not participate with the plan.

  • TriCare Extra
  • TriCare Prime
  • TriCare Prime Remote
  • TriCare for Life
  • TriCare Standard

United Healthcare

  • All Savers Alternate Funding
  • All Savers Fully Insured
  • United Healthcare (HMO, PPO, POS)
  • United Healthcare of the River Valley
  • Compass - Duke Medicine does not fully participate in this plan
  • Compass Balanced  - Duke Medicine does not fully participate in this plan
  • Compass Plus  - Duke Medicine does not fully participate in this plan
  • Navigate HMO, Navigate Balanced HMO, Navigate Plus HMO
  • Navigate Balance 
  • Navigate Plus
  • United Medical Resources (UMR)
  • OneNet PPO

Medicare Advantage insurance plans

Aetna Medicare Advantage (HMO & PPO)

  • Aetna Medicare Value Plan (HMO)
  • Aetna Medicare Open Access Plan (HMO)
  • Aetna Medicare Premier Plan (PPO)
  • Aetna Medicare Plan (HMO, PPO)
  • Aetna Medicare Prime Plan (HMO, PPO)
  • Aetna Medicare Select Plus (HMO, PPO)

Blue Cross Blue Shield of North Carolina

  • Blue Medicare HMO (HMO0)
  • Blue Medicare PPO (PPO)

Coventry

  • Coventry Advantra Freedom (PPO)
  • Coventry Advantra Gold (HMO)

Gateway Health Plan

  • Gateway Health Medicare Assured Select  (HMO)
  • Gateway  Health Medicare Assured Prime (HMO)
  • Gateway Health Medicare Assured Choice (HMO)

Humana

  • Humana Gold Plus (HMO
  • Humana Choice (PPO)
  • Humana Gold Choice (PFFS)

United Healthcare

  • AARP Medicare Complete (HMO)
  • AARP Medicare Complete Essential (HMO)
  • AARP Medicare Complete (PPO)
  • AARP Medicare Direct Essential (PFFS)
  • (DUHS hospitals and physicians do not participate in these plans. Participation in these plans is limited to PDC providers only

Please note that the list above is kept as current as possible, but information may change at any time without notice. 

For services typically covered by insurance, we bill your:

  • Primary insurance company
  • If applicable, your secondary insurance company
  • Medicare
  • Medicaid

Important items to remember:

  • Health insurance coverage varies and some services may not be covered.
  • If you have questions regarding your health insurance coverage, please call your insurance 
company to better understand how your policy works prior to receiving care at Duke.
  • Respond promptly to requests from your health plan for additional information. These requests 
must be handled before payment will be made by your health plan.

Health insurance marketplace products

As you prepare to make decisions about your health benefit coverage for 2015, we encourage you to select a product that allows you continued access to the world renowned care you’ve come to expect from Duke Medicine. Certain products offered in the Health Insurance Marketplace (aka Exchange) do not allow you to see a Duke Medicine provider without a significant out of pocket expense.

Duke Medicine is participating in the following Marketplace products offered in 2015. Enrollment in any of these products will allow continued access to Duke Medicine:

  • Coventry One/Duke Medicine – all plans
  • BCBSNC Blue Advantage
  • BCBSNC Blue Select
  • BCBSNC Blue Options

Duke Medicine is NOT participating in the following Marketplace products. Selection of one of these products will result in significantly higher out of pocket costs to you to receive services from Duke Medicine doctors and hospitals.

  • BCBSNC Blue Value
  • United Healthcare Compass

If you have already selected one of these products, you can change your selection to one that includes Duke Medicine, but the change must be completed by February 15, 2015. After that date, changes cannot be made until the next open enrollment period.