Contingency plan for members in place as Duke Health, state battle

(The Center Square) – The board that regulates North Carolina's state health insurance plan on Friday approved a contingency plan to provide health care for members if Duke Health leaves the network in a few weeks over a pricing dispute.

Duke and Aetna, which administers the North Carolina state plan, are locked in a contract dispute over how much Duke will be paid for services. The contract expires in about three weeks.

About 23,000 members of the North Carolina health insurance plan have Duke as their primary care provider and 40,000 have filed a claim with Duke for medical services this year.

State treasurer Brad Briner has said that if Duke's demands for higher reimbursements are met, it would force the state to raise premiums in 2027. The state recently approved a premium rate increase that will take effect next year, even with an extra $100 million appropriated by the Legislature this year.

At a meeting of the North Carolina State Health Plan board on Friday, Briner said Duke Health used "very aggressive tactics with the intent of scaring our members."

Those include radio ads and letters sent to members, urging them to put pressure on the state to "give into their demands," Briner said.

Aetna and Duke do not appear to be close to an agreement, the treasurer said.

Under state law, if Duke leaves the insurance network, it must continue to provide care for cancer and maternity patients, Briner told the board.

"They will not be turned away," he said. "But there is some paperwork that's required to do that."

The board on Friday authorized hiring contract medical providers for the other members of the state health plan served by Duke.

"This is a step we've never taken before," Briner said.

In a statement, Duke said the negotiations are not about profit but about ensuring quality care.

"Despite escalating costs in pharmaceuticals, supplies, and labor, Duke Health has not received a rate adjustment from Aetna in four years," Duke said. "We are asking for modest increases that are less than the rate of inflation."