RALEIGH, N.C. (AP) — In a authorized battle involving two medical insurance corporations searching for to handle North Carolina’s public worker advantages plan, a decide dominated Monday that the plan’s board acted correctly when it switched to Aetna and dropped longtime administrator Blue Cross and Blue Protect of North Carolina.
Contract prices — with well being care claims included — exceed $3 billion yearly.
Blue Cross has administered the State Well being Plan for over 40 years. The administrator handles well being care bills for a number of hundred thousand state staff, lecturers, their relations and retirees, making certain claims are paid and constructing out a supplier community. After a bid course of, the plan’s trustee board voted in December 2022 to award the preliminary three-year contract to Aetna over Blue Cross and a unit of United Healthcare, which additionally competed.
Blue Cross challenged the choice, arguing that the State Well being Plan erred in the way it determined which firm would get the contract and calling the bid course of oversimplified and arbitrary. However Administrative Legislation Decide Melissa Owens Lassiter, who heard the contested case in February, wrote Monday that Blue Cross had not met the burden of proof vital to point out that plan leaders had acted erroneously or didn’t comply with correct procedures.
“The preponderance of the proof confirmed that the Plan performed the procurement rigorously and thoughtfully, pretty and in good religion, and that its selections had been correctly inside its discretion,” Lassiter wrote in affirming the trustee board’s determination to present the award to Aetna. It’s unclear if the ruling might be appealed to Superior Courtroom.
Blue Cross mentioned it was upset within the ruling however “gratified that the court docket reviewed the intense questions we raised” concerning the State Well being Plan’s proposal request course of. “Blue Cross NC is honored to serve our lecturers, public security officers and state staff and can proceed to offer the best degree of service all through the present contract,” the corporate mentioned in a written assertion.
State Treasurer Dale Folwell, the trustee board chairman, praised the ruling, saying it had been clear that the State Well being Plan “carried out a well-reasoned, high-integrity, and proper procurement course of for third-party administrative providers.”
Aetna North Carolina market president Jim Bostian mentioned a number of hundred of its staff to date have labored on implementing the contract on time “whereas demonstrating in court docket that the transition to Aetna is in the most effective pursuits of the State Well being Plan and its members.”
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