Health insurance

Does Duke Medicine accept my health insurance plan? This is one of the most common questions 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 carriers and transplant networks. 

Please call your insurance company and ask if you have access to health care services at Duke Medicine locations, and what (if any) co-payments, co-insurances, and deductibles will be your responsibility.The Duke Consultation and Referral Center (888-275-3853) can also review the list of Duke Medicine accepted insurance plans with you. 

Important points to consider

Duke Medicine is contracted to participate with insurance products and provider networks that offer both primary and specialty care.

Primary care. If your benefit plan requires the selection of a primary care provider (i.e. a doctor, nurse practitioner or physician assistant), please make sure your Duke provider participates in the product you have selected, and can refer you to Duke if you need specialist care or hospitalization.

Specialty care. Your benefit plan may require you to obtain a referral from your primary care provider in order to receive coverage for services provided by one of our specialists.

Not all services are covered. We may offer certain services that your plan does not cover. For example, some insurance contracts do not include mental health or transplant services in their plans. If you have questions about your coverage, please call your insurance company to better understand how your policy works prior to receiving care.

Geographic limitations. Your benefit plan may limit the geographic area you are permitted to receive care in. This is typically referred to as a “narrow” or “limited” network. Out of network penalties can result in significant out of pocket expense.

Respond to plan requests. Your health insurance carrier may request information from you, including requests for information about other health insurance coverage you may have. Please respond to those requests promptly as they must be handled before payment will be made by your health plan.

Medicare and Medicare Advantage. Duke Medicine participates with Medicare, and many of the Medicare Advantage plans offered in the North Carolina market, but not all of them (view list here). Contact your Medicare Advantage health plan to verify Duke Medicine’s participation prior to scheduling. Out of network penalties can result in significant out of pocket expense.