The North Carolina Association of Educators (NCAE) has received reports from its members of changes in out-of-pocket expenses for medical services covered by the state health plan. Educators and other state employees began noticing these changes in January, after the state health plan switched administrators from Blue Cross Blue Shield to Aetna.
“It varies from individuals sharing that they are now paying fees that they didn’t have before for prescription medicine, or co-pays that they didn’t have to pay before for visits they’ve done plenty of times over the years,” said NCAE’s president Tamika Walker Kelly.
Walker Kelly said this is especially concerning because official communication that state health plan members received about the switch to Aetna emphasized that members’ coverage would not change.
“We were expecting that the transition from Blue Cross Blue Shield to Aetna would be fairly seamless, and that is not what we’re hearing from educators in the field and on the ground,” Walker Kelly said.
The state health plan covers about 750,000 members. About a third of policy holders are employed by public schools, according to the state treasurer’s office.
Issues linked to providers no longer signing up for the Clear Pricing Project
North Carolina’s new state Treasurer Brad Briner said his administration is aware of concerns from state health plan members, but that the issues are specific to the application of the Clear Pricing Project, not with co-pays more broadly.
Under the Clear Pricing Project, state health plan members can choose a healthcare provider who supplies transparent pricing to the state in exchange for lower co-pays for patients. Many of the providers who have participated are in the fields of primary care or mental health. All providers in the Clear Pricing Project had to take action to remain in the program this year, while in past years they did not need to re-enroll annually.
Briner’s advice to state health plan members who have seen a co-pay change is to ask their doctor’s office whether their provider signed up for the Clear Pricing Project.
“In the context of the transition from Blue Cross to Aetna, it has come to our attention that some providers meant to sign up for CPP again and did not complete (it) for one reason or another,” Briner told WUNC.
Briner said his office is reaching out to providers who made good faith efforts to sign up and had technical issues. As evidence of a “good faith effort,” the treasurer’s office is tracking email communication and visits to the state health plan’s website.
However, Briner said some providers simply missed multiple deadlines last year to sign up.
“Some of them are now saying they meant to, and I don’t think we’re in a position — given the massive deficit the state health plan is in right now — of retroactively giving increases in reimbursement to the folks who did not sign up for the plan and missed three deadlines,” Briner said.
Briner said the Clear Pricing Project was well-intentioned, but in practice has cost the state health plan too much. It offered providers payments based on a percentage of Medicare reimbursements.
“Those who got paid more to be members of the CPP joined, and those who did not, did not, because they were not forced to,” Briner explained.
On a call with reporters last week, Briner said the board of the state health plan could consider ending the program, saying that “anything is on the table.” He told WUNC this week that the board might also consider offering the program only to mental health providers.
State employees also face possible premium hikes based on salaries
The North Carolina State Employees’ Association (SEANC) said it has received relatively few complaints with the state health plan change from its members.
“We’re hearing more about what they’re worried about is coming in the future,” said Ardis Watkins, executive director of SEANC.
Briner has said publicly premiums could go up for state employees by $20 a month or more. The state health plan board is expected to vote later this week on whether to pursue variable premiums based on an employee’s salary. Watkins said that proposal could particularly impact veteran teachers.
“There are some teachers who were more experienced who did not get raises — or did not get meaningful raises — but because they might earn more for having been there for 20 years, they would have to pay more for their health care than somebody else,” Watkins said.
Even with potential premium hikes on the horizon, Watkins said SEANC’s biggest long-term concern with the state health plan has, and continues to be, a lack of transparency in pricing for healthcare services.
Watkins said healthcare providers in North Carolina charge the state health plan anywhere from 90% to 800% of Medicare reimbursement rates.
“That’s all we know about the plan,” Watkins said. “It’s public money spent on these contracts to take care of public employees, and yet the public can’t see that.”
Forbes Advisor has ranked North Carolina the most expensive state for healthcare and the third worst for healthcare quality in the country.
“We’ve got great accessibility. You don’t have to go far to get to a doctor or a hospital,” Watkins said. “But when you get there, the quality of the care is third from the bottom, and the cost of the care is number one most expensive in this country.”
Educators see state health plan as one of their last remaining benefits
Walker Kelly said NCAE’s biggest question is:
“Is it just transitional issues going from one administrator to another, or was the state health plan fully prepared to take on this switch?” Walker Kelly said.
Walker Kelly said changes to the state health plan are a serious matter for educators because over the last fifteen years, the state has removed other benefits for newly hired teachers, such as master’s pay, longevity pay and state-funded health insurance upon retirement.
“The state health plan is one of the remaining benefits that our educators here in North Carolina depend on,” Walker Kelly said. “That is why this one feels particularly pointed for our educators.”
