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In NC Marketplace, CHS Pushes Patients Toward Certain Plans

James Willamor

Now that the health insurance marketplace is open, Carolinas HealthCare System is pushing people to sign up for plans that include its hospitals and doctors.

The marketplace or exchange, as you've probably heard by now, is the new website where you can sign up for health insurance. In Mecklenburg and 38 other North Carolina counties, you have two companies to choose from: Coventry Health Care and Blue Cross Blue Shield.

And the Charlotte area's largest hospital system is sending patients mail that says to keep getting your care from us, Coventry Health Care is quote: "the most affordable option."

"I think as a general rule, we are encouraging everyone - whether they choose Coventry or otherwise - just to make sure that they know if we are in the network," Joe Piemont said in an interview. He's the president of Carolinas HealthCare System.

Insurance companies put together their cheapest plans in part by limiting the doctors and hospitals you can go to. It can come down to negotiations between the insurance companies and the hospital systems.

Piemont says Coventry gave Carolinas HealthCare the best deal.

"We'd had similar conversations with Blue Cross, and we are in several of the Blue Cross products, just not all of them," he said. "On some of them, we were just simply unable to reach acceptable terms."

Piemont downplays the role price played in the negotiations. He says Carolinas HealthCare was just as interested in what the plans would cover, what they'd leave out, and how much of a say the hospital system would have going forward in those decisions.

The end result is that Coventry offers a plan with a narrow network that includes Carolinas HealthCare, while Blue Cross has a narrow network that includes Novant Health, the other big hospital system in the Charlotte area. 

But Novant isn't allowed to tell people to choose the plans that include its hospitals and doctors. Senior Vice President Bob Seehausen says that's because Novant is asking the federal government to designate it as an organization that'll help people use the marketplace. It's called a certified application counselor, or CAC.

"We're going to let people know which networks we participate in, and we're certainly going to hope that they sign up with us," Seehausen said. "But one of the obligations of being a CAC organization is that you don't steer people; you take a balanced approach to explaining what options are available in the marketplace."

Seehausen points out Novant is also part of a few Coventry plans, just as Carolinas HealthCare is part of a few Blue Cross plans.

He and Piemont from Carolinas HealthCare agree on this point: everyone using the marketplace should be aware of the hospital networks that are – and are not – included in the plans.