With details scant, NC health plan switch confuses and frustrates some state workers
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State Health Plan
The State Health Plan’s board of trustees voted in a closed-session meeting to award Aetna a contract that has been in the hands of Blue Cross NC for more than 40 years. But the details are still shrouded in secrecy. The vacuum of information has been filled with questions from state employees and few clear answers from those in charge of the health plan.
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Bambie Lockhart, a teacher in Wake County for 22 years, heavily depends on the State Health Plan to afford the slew of doctors and services that help her manage thyroid cancer.
So after the state treasurer’s office announced Jan. 4 that it would replace the health plan’s longtime administrator, Blue Cross NC, with Aetna, Lockhart started to panic.
Would she have to spend days finding a new team of surgeons and oncologists to manage her cancer? Would she have to find a second job to afford her premium?
Lockhart said she didn’t receive any emails or letters from the State Health Plan explaining what the change meant for her health coverage, so she took matters into her own hands.
She emailed her doctors at UNC to see whether they would still accept her insurance after Aetna took over the contract in 2025 — they didn’t know. She searched Twitter for anyone who knew what the changes meant.
Ultimately, she gave up:
“I’m not equipped with the tools of knowledge of what to research,” she said. “We’re all in limbo because we have no idea what’s going to be covered.”
Citing concerns about Blue Cross NC’s transparency and costs, the state plan’s board of trustees voted in a closed-session meeting to award Aetna a contract that has been in the hands of its predecessor for more than 40 years.
But the details of the state’s new agreement with Aetna are still shrouded in secrecy. There is a “silent period” in effect until the contract is finalized, during which those involved in the decision are barred from talking about certain details of the deal by nondisclosure agreements and the contract is not released to the public. The silent period could last several more weeks while Blue Cross NC appeals the decision.
The vacuum of information has been filled with questions from state employees and few clear answers from those in charge of the health plan.
Folwell: No changes to employees’ costs
State Treasurer Dale Folwell said a switch from Blue Cross NC to Aetna will neither change the list of drugs covered by the health plan, nor its copays, deductibles, or premiums. The change could affect which health care providers are considered “in-network,” though it’s still unclear how extensively the provider network will change.
Even the most seasoned health care consumers, like Carl Newman, had a difficult time understanding how the change would impact them.
When Newman, a State Health Plan member who works in the attorney general’s office, heard about the new contract, he said he immediately worried about how it would impact his ability to get his expensive rheumatoid arthritis drugs.
Any disruption to his health insurance — a new prior-authorization requirement, different paperwork, or a change in providers — could delay him getting a critical dose of his medication, he said.
Even Newman, who said he “navigates bureaucracy for a living,” couldn’t figure out how the shift would change his health care.
“I don’t actually know that we’ve gotten any details from the treasurer’s office about what this actually means for my coverage,” said Newman, who also holds a leadership position in but does not speak for the NC Democratic Party. “What does this actually mean for my care?”
Lockhart said she wished the treasurer’s office would have better communicated what aspects of health care would be affected by the shift to Aetna.
“Anything would have made us feel better,” she said. “Anything we could hold on to that said ‘OK, we don’t have to worry about doctors or we don’t have to worry about drugs.’”
State employees’ questions
The treasurer’s office is “preparing a robust communications plan” to send to members over the next two years, before Aetna takes over in 2025, said Frank Lester, a deputy treasurer in the office. He said they are also reaching out to health benefit representatives, who manage health plan communications within covered organizations, and stakeholder groups to discuss the change.
Folwell emphasized that his office only “focuses on the members and what’s in their best interest”.
But Kim Mackey, a state plan member who teaches personal finance in Wake County, said she thinks that’s too long for state employees to question the future of their health care.
“That’s an awfully long time for there to be so many question marks,” she said.
Ardis Watkins, executive director of the State Employees Association of North Carolina, said her organization will be educating itself and its members on what the change will mean in the next two years.
“State employees are always wary of change,” she said in a statement. “Rest assured, we will be representing our members’ concerns…”
Watkins earlier told The News & Observer that in SEANC’s experience, “the Plan’s leadership has the interests of state employees and retirees at heart.” And the group said in a post on its website that “drastic changes” had been necessary:
“The Plan is now at a crossroads, where without drastic changes, members would likely see rising costs in the next three years to stay solvent.”
Transparency cited as factor
Folwell, a Republican, said the decision to oust Blue Cross came down to an internal scoring system on which Aetna ranked higher than its two competitors. He also cited concerns with Blue Cross NC’s transparency and software, which the health plan’s board of trustees said caused major disruptions in 2022.
Mackey said she is skeptical that these changes will benefit state employees. She said she worries about the lack of details surrounding Aetna’s provider network and the frequency with which the company denies claims.
“As much as the treasurer talks about transparency being a motivating factor, there hasn’t been a whole lot of information for members,” she said.
Teddy Rosenbluth covers science and healthcare for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.
This story was originally published January 15, 2023 at 6:00 AM with the headline "With details scant, NC health plan switch confuses and frustrates some state workers."
