The state heath insurance plan is going to help members who use Duke doctors find alternative medical providers, as protracted negotiations over payments drag on.
Duke Health and Aetna, the health plan’s third-party administrator, have been locked in negotiations for months. The contract between Aetna and Duke Health expires Oct. 20. State Health Plan trustees approved a resolution Friday that will have offer “white-glove service” to beneficiaries who use Duke in helping them find new doctors.
Aetna insures about 1.5 million North Carolina residents, including about 750,000 through the state employee health plan. If there’s no agreement by Oct. 20, Duke Health will no longer be part of Aetna’s provider network, and most patients who continue to see its doctors will pay higher costs. That means thousands of state employees and teachers would pay higher medical bills if they remain Duke patients.
Adopting a contingency plan is unprecedented move, and state Treasurer Brad Briner said he is holding out hope for an agreement by the contract deadline.
“If we end up out of network, Duke is the one who made that choice,” he said. “They will have made that choice that their financial goals are more important than their mission to serve.”
He criticized what he called Duke’s “aggressive tactics” – radio ads and letters to beneficiaries – which he said were meant to scare them and convince them to argue on the health system’s behalf.
Briner said the public pressure campaign was beneath one of the state’s preeminent non-profit hospitals.
In a prepared statement, Duke Health said it is continuing good-faith negotiations with Aetna to ensure patients covered under the insurer’s plans can continue uninterrupted access to Duke primary care doctors and specialists.
“We have a responsibility to our patients to communicate about potential impacts to Duke Health care access,” said the statement attributed to Duke Health officials. “They may need more time than the required notice period allows. We’ve sent communications to our patients to provide them with context on the negotiations, continuity of care and how they can provide feedback to both negotiating parties, Duke Health and Aetna.”
Despite rising costs, Duke Health has not received a rate adjustment from Aetna in four years, the statement said, adding that the increases it is requesting are below the rate of inflation.
“We recognize and understand the pressures facing the State Health Plan,” the statement said. ”Less than 6% of State Health Plan members receive care at Duke Health and the modest increases we’re seeking from Aetna would have minimal to no effect on premiums.”
The 22,000 people on the state health plan and who have a Duke primary care doctor, and about 40,000 members who have filed a claim through Duke this year will be contacted about finding new medical providers.
About 2,800 people on state health insurance who use Duke Health for treatments are protected under the continuity of care law. They will be able to continue to use Duke Health as an in-network provider after the contract expires, but need to fill out paperwork. These are mostly patients receiving maternity care or cancer treatments.
Duke Health came under blistering criticism from Dr. Brian Miller, a health plan trustee, who recited figures from Duke Health’s financial audits, and noted its $4.3 billion in investments.
“This does not sound like a health system that is in financial distress,” he said. “Duke is choosing to prioritize its investment portfolio instead of the heath of local citizens who work as custodians, help take care of parks, local teachers. They would rather pad their investment portfolio off the backs of these workers. I find that a fundamental moral failure, and I am sincerely disappointed.”
Health Plan Executive Director Tom Friedman said after the trustees meeting that the plan asked every provider to either hold the line on costs or even take less next year as the plan moved to close its financial hole. It cannot now give one provider a lot more after asking others to sacrifice, he said.
“How are we going to look them straight in the eye and say ‘Yes, this was fair,” Friedman said.
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