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DURHAM, N.C. (WNCN) — The clock is ticking for Aetna and Duke to reach a deal. If they can’t, local families could be forced to pay out of pocket for care.
The battle over money is now putting patient health on the line, including thousands of state employees.
The State Health Plan’s Board of Trustees met Friday to discuss the matter and help state employees who use Duke Health possibly find other providers if Duke and Aetna can’t come to an agreement in the coming weeks.
“As of this moment, we do not think they are close to an agreement,” said State Treasurer Brad Briner during Friday’s board meeting.
Aetna is the third-party administrator for state employees, which means those who go to Duke Health for treatment could be affected by the dispute.
According to Duke Health, in 2024, less than 6-10% of state health plan participants used its services.
“Duke is demanding a significant raise off the back of our hardworking state employees,” said Briner during Friday’s meeting. “If we end up out of network, Duke is the one who made that choice. They will have made the choice that their financial goals are more important than their mission to serve.”
In a statement from Duke Health Officials, they said in part, “These negotiations are not about profit, but instead about ensuring that Aetna patients continue to receive the exceptional care they deserve without disruption.”
The Board of Trustees adopted a resolution Friday permitting State Health Plan employees to help transition members to other providers if negotiations fail.
“About 2,800 of our members use Duke Health and have course of treatment, which are protected under state law,” one board member said. “These are primarily cancer patients and people in the maternity process. For the foreseeable future, they will continue to see Duke Health on an in-network basis. they will not be turned away, but there is some paperwork that’s required to do that.”
Recent statements from Duke Health Officials said in part; “Duke Health, North Carolina’s top-ranked health care system, is currently in good faith negotiations with Aetna to ensure patients covered by Aetna insurance plans continue to have uninterrupted access to their trusted Duke Health physicians and specialists.
“Our goal is to secure fair and sustainable reimbursement rates that reflect the true cost of delivering high-quality care. Despite escalating costs in pharmaceuticals, supplies, and labor, Duke Health has not received a rate adjustment from Aetna in four years. We are asking for modest increases that are less than the rate of inflation.
“We recognize and understand the pressures facing the State Health Plan. Less than 6% of State Health Plan members receive care at Duke Health and the modest increases we’re seeking from Aetna would have minimal to no effect on premiums.
“We’ve also agreed to — and will continue to agree to — value based reimbursement, which compensates health care providers who delivers the highest quality care most efficiently and lowers total cost of care, a goal both Duke and Aetna share.
These negotiations are not about profit but instead about ensuring that Aetna patients continue to receive the exceptional care they deserve, without disruption.”
Additionally, Duke Health released this video.
An Aetna spokesperson tells CBS 17, “Aetna is committed to providing access to affordable, quality health care for our 1.5 million members in North Carolina. We are negotiating in good faith with Duke Health — a partner for several decades — to enable members to continue receiving in-network care at all of their locations.
“We have a responsibility to offer a cost effective, quality provider network to our customers. Payment to providers participating in our networks directly impacts health care costs and we have an established track record of working collaboratively with health systems in North Carolina toward fair and market-competitive reimbursement.
“North Carolina has among the highest health care costs in the country and Aetna is unwavering in our effort to protect our North Carolina members from additional escalations in costs. Our discussions are ongoing and our intent is to reach a mutually agreeable outcome with Duke Health.
These negotiations have no impact on Aetna members accessing Duke Health today.”
The current contract between the two is valid until Oct. 19.
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Mary Smith
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