- Analysis of public documents reveals Blue Cross NC offered the lowest total cost by nearly $45 million over the life of the three-year contract.
- Blue Cross NC offered the broadest network, ensuring that teachers, state employees and their families could continue to see the doctors they know and trust.
- The State Health Plan’s oversimplified process and arbitrary scoring failed to deliver the lowest cost and best access to care.
DURHAM, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) filed a legal challenge on Thursday to the North Carolina State Health Plan’s decision to award the 2025-2027 contract for third-party administrative services to Aetna. The filing highlights the oversimplified and arbitrary bid process that resulted in a more expensive contract with a smaller network of providers.
The litigation was filed in Durham County Superior Court and the Office of Administrative Hearings. Jurisdiction is likely to be determined by the Office of Administrative Hearings in the coming weeks.
Blue Cross NC Offered the Lowest Cost by $45M
Documents released by the State Health Plan show that Blue Cross NC offered the bid with the lowest total cost by nearly $45 million over the life of the three-year contract.
- Aetna’s winning bid will cost $9,932,800,000 from 2025 through 2027, nearly $45 million more than Blue Cross NC’s proposal of $9,888,100,000 over the same time period.
- Blue Cross NC’s proposal had the lowest administrative fees and tied for first on network pricing.
Blue Cross NC Offered the Broadest Network for Plan Members
Blue Cross NC also offers State Health Plan members and their families the broadest statewide network, allowing them to keep the doctors they know and trust.
- Based on a preliminary review of publicly available information, Blue Cross NC’s statewide network of total provider locations appears to be 38% larger than Aetna’s.
- In Aetna’s cost proposal, thousands of its “in network” claims reflect providers that are not yet part of its network.
Bid Process Failed to Deliver Lowest Cost and Best Access to Health Care
The State Health Plan’s oversimplified process, the limited information gathered in the Request for Proposals and the arbitrary scoring process resulted in the State Health Plan paying more and getting less.
- The State Health Plan RFP did not compare the bidders’ networks of providers. It scored the companies’ networks on only a pass-fail basis.
- The RFP relied on yes/no questions on 310 highly complex technical requirements and prohibited Blue Cross NC from providing explanations of capabilities or helpful context.
Additional documents and background information can be found on the Blue Cross NC Media Center.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina (Blue Cross NC), the leading not-for-profit health plan in North Carolina, is committed to making health care more affordable, easier to navigate and accessible for all. Since 1933, the health insurer has created programs and initiatives to provide North Carolinians the opportunity to be healthy. Blue Cross NC serves its customers and communities of more than 4.2 million members, including approximately 1.1 million on behalf of other Blue Plans. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. Visit Blue Cross NC online at www.bluecrossnc.com. All other marks are the property of their respective owners.