BCBSNC files legal challenges to state employee health contract

Published 9:49 am Sunday, February 19, 2023

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Blue Cross and Blue Shield of North Carolina filed legal challenges Thursday to the state employee health plan’s recent decision to replace the insurer with another company to administer the plan.

Blue Cross filed separate petitions with the state Office of Administrative Hearings and in Durham County Superior Court.

The State Health Plan’s Board of Trustees in December voted for Aetna to become the plan’s third-party administrator starting in 2025 for at least three years. Blue Cross, the state’s dominant insurer, has held the job for more than 40 years. A unit of United Healthcare also filed a bid.

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The administrator handles health care expenses for several hundred thousand state employees, teachers, their family members and retirees, ensuring claims are paid and building out a provider network. Contract costs — health care claims included — exceed $3 billion annually.

Blue Cross contends the bid process was oversimplified and arbitrary, stating that it offered the lowest-cost proposal and its provider network is larger than Aetna’s. The company said it filed petitions at both venues because the case’s jurisdiction hasn’t been finalized.

The State Health Plan last month rejected requests by Blue Cross and the United Healthcare subsidiary for agency meetings to appeal the decision.