WakeMed spat with Blue Cross could leave thousands without full insurance coverage

Dec. 14--A contract dispute between WakeMed Health & Hospitals and Blue Cross and Blue Shield will leave several thousand people in the Triangle without full insurance coverage unless they switch plans this week. The enrollment deadline is Thursday, Dec. 15, to buy ACA coverage effective Jan. 1.

The residents potentially exposed are currently insured on Blue Cross's Blue Value plan, purchased through the Affordable Care Act or directly from Blue Cross. That insurance plan pays for medical services by hospitals and doctors affiliated with UNC Health Care and also with WakeMed. The WakeMed component includes hospitals, clinics, labs and about 800 doctors in the Triangle.

Starting in 2017, however, WakeMed will not be included on the Blue Value plan. Blue Cross proposed cutting reimbursement rates for the WakeMed network providers, so WakeMed refused to sign the deal. WakeMed CEO Donald Gintzig said WakeMed providers are already paid less than doctors in the larger networks, UNC and Duke Medicine.

"They're trying to save money," Gintzig said. "They're trying to pay us less than they paid us before."

Seeing WakeMed doctors or using WakeMed facilities on the Blue Value plan in 2017 would count as out-of-network coverage, which can cost up to 10 times as much as in-network coverage, which is fully insured.

But Gintzig said that people who switch to Blue Cross's Blue Local plan by Dec. 15 will be able to keep their WakeMed providers near year and be considered in-network. Blue Local also includes Duke Medicine doctors and facilities. Both Blue Local and Blue Value are offered in the Triangle.

"What you don't want to have in a narrow network plant is out-of-network utilization," said Ray Coppedge, director of WakeMed Key Community Care, the organization that negotiates WakeMed's reimbursement rates and terms with Blue Cross. "Your insurance is good only within that narrow network environment."

Blue Cross declined to discuss the details of the negotiations. The Durham-based insurer lost $405 million on its ACA plans in the past two years and is trying to control costs by raising rates by 24.3 percent on average next year.

"WakeMed chose to leave the Blue Value network because they are participating in our other narrow network product Blue Local with Duke Medicine and WakeMed," said Blue Cross spokeswoman Ryan Vulcan in an email.

Blue Value covers about 6,000 people, but some aren't affected by the contract dispute because they primarily use UNC doctors and facilities, including UNC Rex Health Care in Raleigh.

John Murawski: 919-829-8932, @johnmurawski

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