Blue Cross NC appeals loss of state worker contract to Aetna

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RALEIGH, N.C. (AP) — Blue Cross and Blue Shield of North Carolina on Thursday formally appealed the state employee health insurance plan’s decision to choose another company to manage the plan after more than 40 years.

Blue Cross, the state’s dominant insurance company, has filed a protest meeting request with State Health Plan Acting Director Sam Watts. The plan’s board of trustees voted last month to replace Blue Cross with Aetna starting in 2025. State Treasurer Dale Falwell announced the winner of the bid last week.

As the next third-party administrator, Aetna could control more than $17.5 billion in health care spending over five years, the plan said. The work involves paying medical bills for several hundred thousand government employees, teachers, their families and retirees, securing claims payments and building a network of providers.

In a letter of protest, a Blue Cross attorney said in part the bidding process put together by the plan was simplistic, the scoring system arbitrary, and that it didn’t take into account how changing a provider network could hurt plan members. Durham-based Blue Cross estimates its provider network is nearly 40% larger than Aetna’s.

RALEIGH, N.C. (AP) — Blue Cross and Blue Shield of North Carolina on Thursday formally appealed the state employee health insurance plan’s decision to choose another company to manage the plan after more than 40 years.

Blue Cross, the state’s dominant insurance company, has filed a protest meeting request with State Health Plan Acting Director Sam Watts. The plan’s board of trustees voted last month to replace Blue Cross with Aetna starting in 2025. State Treasurer Dale Falwell announced the winner of the bid last week.

As the next third-party administrator, Aetna could control more than $17.5 billion in health care spending over five years, the plan said. The work involves paying medical bills for several hundred thousand government employees, teachers, their families and retirees, securing claims payments and building a network of providers.

In a letter of protest, a Blue Cross attorney said in part the bidding process put together by the plan was simplistic, the scoring system arbitrary, and that it didn’t take into account how changing a provider network could hurt plan members. Durham-based Blue Cross estimates its provider network is nearly 40% larger than Aetna’s.

The state health plan had agreed to pay $79 million in administrative costs to Blue Cross through 2022 under an existing third-party contract.

Folwell’s office said the contract would affect 740,000 plan members. But Blue Cross said the contract covers 580,000 people — leaving out those enrolled in Medicare Advantage plans.

For years, Fowell has been unhappy with Blue Cross because of barriers to access to company records that he says would show whether the plan is getting the best prices for members’ medical expenses from insurers. Legislation that passed the General Assembly in 2022 but did not become law could have addressed this.

A published report this week highlighted recent unhappiness among plan officials about the software system used by Blue Cross.



Blue Cross NC appeals loss of state worker contract to Aetna

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