New NC State Health Plan agreement will avoid big cost hikes for using some Atrium hospitals

Some North Carolina employees and teachers insured through the State Health Plan and seeking care at certain Atrium Health hospitals and clinics won’t see big jumps in their out-of-pocket costs after all. 

State Treasurer Brad Briner announced Monday that a dozen Atrium hospitals will be in a benefits tier that will keep their out-of-pocket expenses next year about the same as they are this year. Costs won’t change for members who see Atrium primary care doctors. 

In an attempt to control costs, the State Health Plan is moving to a tiered benefits system intended to push members to “preferred” hospitals and providers with which it has contracts.  Atrium Health, the state’s largest healthcare system, was originally frozen out of the two lower-cost tiers with its“non-preferred” status, meaning that out-of-pocket costs for members  would increase for hospital visits, specialists, out-patient surgeries and other services. 

Atrium complained and at least one legislator came to its defense. 

Rep. Brenden Jones, Republican majority leader from Columbus County, wrote Briner after State Health Plan trustees approved the system that relegated Atrium Health to a more expensive tier, saying it would hurt rural residents, doctors and hospitals. 

Atrium hospitals in Alleghany, Anson, Cleveland, Columbus, Lincoln, Scotland, Stanly and Wilkes counties, and the Levine Children’s Hospital in Charlotte, the Jeff Gordon Children’s Hospital in Concord and the Brenner Children’s Hospital in Winston-Salem are moved into what’s called the “access” tier, Briner’s office announced Monday. That designation will mean out-of-pocket costs  for members who seek care at those hospitals will remain about the same next year.

“This agreement includes meaningful affordability commitments from Atrium Health that help us improve access for members while supporting the long-term sustainability of the Plan,” Briner said in a statement. “This new provider tier system, which has now forged partnerships with all of the state’s leading hospital systems, is putting us on the right path.”

UNC Health and Novant Health are preferred providers. Duke Health is an access provider. 

“We appreciate the collaborative work that made this agreement possible and look forward to continuing discussions about how we can continue to improve access, quality and affordability for North Carolinians in the future,” Michael Parkerson, executive vice president and chief managed health officer for Advocate Health, said in a statement. Atrium Health is a part of Advocate Health.