As this state’s treasurer, Dale Folwell is the steward of public funds eight times the size of the overall state budget  – and that’s only half of what his department oversees.

Folwell has been leading the charge to transition to make Aetna the company that processes insurance claims, replacing Blue Cross NC. This change will take place beginning January 2025.

Folwell will kick off a promotional bus tour across the state to coincide with the upcoming open enrollment period, when individuals typically have the option to make changes in their plans.

The transition does affect members in the Base PPO Plan, Enhanced PPO Plan and High Deductible Health Plan. It does NOT affect Humana Medicare Advantage Plan members.

Health care and retirement are uppermost on the minds of most state employees – “those who teach, protect and otherwise serve,” Folwell said on Monday’s TownTalk.

Think of the transition from one third-party administrator to another like a car, he said:

The car’s body hasn’t changed – individuals will continue to make copayments, etc. to receive care. The engine hasn’t changed – that’s how the state funds the insurance plans. It’s the transmission – how the state settles claims – that will be undergoing the change.

It’s important to remember that Aetna is NOT the insurance provider, Folwell emphasized.

As a TPA, Aetna’s job is to process claims and make sure they’re correct before presenting them for payment.

We’ve always been self-funded, and Aetna, like Blue Cross NC, is simply a “transmitter” to make sure the billing and payment process is smooth and efficient.

If you’ve ever gotten a bill for a doctor visit or medical procedure and have had questions about what you actually owe and what will be covered by insurance, you’re not alone.

Those involved in the transition to Aetna will have to choose a new primary care provider, but Folwell said he’s confident that they’ll be able to keep their current provider without a problem.

“If people are getting the right primary care, and occasionally any physical therapy they may need,” Folwell said, it will help keep people out of hospitals, which is the ultimate goal.

“I continue to think that people are being gouged on health care pricing as well as prescription drug pricing” in North Carolina, Folwell said.

There’s lots going on in health care, he continued. “It’ sad (people) can’t consume health care – it consumes them.”

When people have a higher fear of the bill than the procedure itself, it should be a cause for concern, he said. And action.

Medical bills can be confusing, to the point that you can’t tell if they had a tonsillectomy or an appendectomy.

But it all comes down to paying for the medical care that you get, and Folwell said his department will partner with any hospital interested in transparent health care, high-quality access at a reasonable cost.

The road tour, featuring Aetna-themed vehicles, will kick off in Raleigh at the Department of State Treasurer’s office later this week on Thursday July 25, then will be at the N.C. General Assembly on Aug. 22.

The tour coincides with the Plan’s 2025 Open Enrollment period, which runs from Sept. 30 through Oct. 25.

The Plan and Aetna are ready to meet people in person during the tour, online or by telephone. For those unable to come out in person, the Plan will also be offering numerous webinars and Telephone Town Halls containing the same information as in-person events.

Learn more at https://www.shpnc.org/

 

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