Blue Cross Blue Shield of North Carolina has been booted . . . from the state health plan, that is.
For decades, hundreds of thousands of North Carolinians have been getting their insurance through the state via Blue Cross Blue Shield of North Carolina (BCBSNC). More than 700,000 current and retired state government workers, along with their family members, are members of the state health plan. But last year, the board in charge of the plan voted to give the contract to Aetna, beginning in 2025.
BCBSNC’s response? Sue the state.
The state’s largest insurer claims “the decision was made due to errors and an unfair scoring process used by the state,” according to a news report from WRAL.
Blue Cross attorney Matt Sawchak reasons that the state will end up paying more for the health plan, with members getting less coverage. (Do we need to remind BCBSNC of its track record of high premiums?)
Aetna, of course, denies that it received the contract because of errors or bias. According to Lee Whitman, an attorney representing Aetna, Blue Cross has faced hefty fines in previous years due to over-billing, dropped coverage, and other issues. Considering this history — alongside Aetna’s success in the state’s updated scoring system — Whitman argues that it’s evident a change is necessary.
So, just what are they debating in court? Many of the legal debates are about how the health plan evaluates the insurance companies to see if they can handle running the plan smoothly and keep costs down. When it comes to these bids, the health plan must assess both cost and the technical issues with administering the plan. Blue Cross argues that the scoring was done unfairly and that they deserve to keep the contract.
Now, state health plans are a big deal. They provide insurance to teachers, police officers, and government workers, among others. That’s a lot of lives — and a lot of premiums. Winning the state health plan contract is quite the boon for an insurer, especially if they can keep claims low.
Put another way, we understand why BCBSNC wanted to win the contract. But we don’t necessarily believe it’s in the best interest of North Carolinians. And in our opinion, suing over spilled milk feels a bit like a waste of resources that would be better spent on their remaining members in the Tar Heel State.
