Blue Cross and Blue Shield of North Carolina is appealing North Carolina's decision to award its state employee health plan contract to Aetna.
In an appeal filed Jan. 12, Blue Cross NC said the state used "limited information" and a "distorted scoring process" in the contract selections.
North Carolina State Treasurer Dale Folwell said Jan. 4 that the state would turn over management of its health plan for state employees to Aetna in 2025. The contract includes healthcare spending of more than $17.5 billion over five years.
Blue Cross NC has held the contract, which covers 740,000 state employees, for over 40 years.
In a Jan. 12 news release, Blue Cross NC said its network in the state is 38 percent larger than Aetna's.
"A smaller network could result in a significant number of teachers and state employees across the state to change doctors they’ve built relationships with for years and travel farther for in-network care," the company said in its statement.
In a statement shared with Becker's, Aetna North Carolina President Jim Bostian said the payer is committed to a "seamless transition" for state health plan members.
"Our team analyzed millions of provider claims processed over a full year by the current state health plan administrator, Blue Cross Blue Shield of North Carolina, and matched them to Aetna’s provider network," Mr. Bostain said. "The result? More than 98 [percent] of BCBS claims came from providers currently in Aetna’s network."
Mr. Bostian said Aetna is working to expand its North Carolina network as well.
Blue Cross NC also said the state's contract selection process removed preference for North Carolina companies. The payer has hundreds of employees that currently administer the state health plan, according to the news release.
Mr. Folwell told CBS17 the state will engage in a "factual, thoughtful and transparent review" of the contracting process.
"Just like Blue Cross Blue Shield of North Carolina has the right to point fingers at everyone else for losing the contract after 44 years, the State Health Plan, Board of Trustees, professional staff and I all have a duty to seek the best financial value and member service for those that teach, protect and serve as well as taxpayers like them," Mr. Folwell said.
Mr. Folwell's office previously said the new contract with Aetna could save the state up to $140 million in administrative costs.