50K BCBS members to lose in-network access to Duke Health, WakeMed

Blue Cross Blue Shield of North Carolina will eliminate a health plan affiliated with Durham, N.C.-based Duke Health and WakeMed Health & Hospitals in Raleigh, N.C., according to WRAL.

BCBS is dropping the plan in an effort to cut premiums for policyholders who purchase coverage on the ACA individual market. However, in the process, BCBS will transfer about 50,000 members who previously had in-network access to Duke Health and WakeMed to a plan that is part of a new contract with Chapel Hill, N.C.-based UNC Health Alliance. The alliance is a physician-led network including UNC Health and independent providers.

BCBS said shifting members to the UNC Health Alliance network will offer lower premiums while maintaining similar health benefits for members who currently access Duke Health and WakeMed at in-network rates. The transition will take place at the end of the year, after which BCBS ACA plan members will have to pay higher costs to access Duke Health and WakeMed.

WakeMed CFO and Executive Vice President Rick Carrico told WRAL the health system is "incredibly disappointed" with BCBS' decision. He added WakeMed offered substantial discounts to the health insurer. Duke Health did not comment.

"We are working closely with Blue Cross NC to minimize the impact on our patients and to ensure those with certain ongoing, acute, chronic or terminal conditions (including pregnancy) can continue to receive the care they need without interruption after Jan. 1," Mr. Carrico said in a statement. "Our leadership team is working closely with another national insurance carrier that offers health exchange products across the country to provide a competitive ACA exchange option that includes WakeMed and Duke. We hope to share details about this plan very soon."

BCBS told WRAL it is "committed to working with our current Blue Local customers to help them find a new in-network provider and to make sure they continue getting the care they need throughout this transition."

The network change only affects ACA exchange plans, not BCBS' other business lines.

More articles on payer issues:
Trump administration releases final rule for short-term health plans: 5 things to know
CMS approves Maine's health insurance waiver: 4 things to know
Kaiser ends Medicaid coverage for 2.5K patients in Colorado

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