Blue Cross NC appeals loss of state worker contract to Aetna

RALEIGH, N.C. — Blue Cross and Blue Shield of North Carolina on Thursday formally appealed the decision by the health insurance plan for public employees to choose a different company to administer the plan after more than 40 years.

Blue Cross, the state’s dominant insurer, filed its request for a protest meeting 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 Folwell announced the bid winner last week.

As the next third-party administrator, Aetna could oversee health care spending of more than $17.5 billion over a five-year period, the plan has said. The job involves handling 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.

In the protest letter, an attorney for Blue Cross said in part the bidding process assembled by the plan was simplistic and the scoring system arbitrary, and that it failed to take into account how a provider network change could harm plan members. Durham-based Blue Cross estimates its provider network is nearly 40% larger than Aetna’s.

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