Payers and Providers Teaming Up to Offer Lower Costs Health Plans but Small Business, Individuals Being Left Out in the Cold

February 02, 2021

At the beginning of the year, a new lower-cost health insurance product hit the market in Charlotte and the Triad.

The state’s largest payer, Blue Cross and Blue Shield of North Carolina, and two of the state’s largest health systems, Atrium and Baptist, launched new Exclusive Provider Organization (EPO) insurance plans.

The premium savings on these products are up to 20 percent. We’re talking hundreds of thousands of dollars in savings.

These savings aren’t achieved by cutting coverage. EPOs aren’t so-called “junk plans.”

They are achieved, rather, by offering coverage only with in-network providers except in the case of emergencies or urgent care. For example, if you have the Blue Cross NC-Atrium EPO plan in Charlotte, you need to go to an Atrium doctor if you want your care to be covered.

Providers know they will likely get 100 percent of the plan’s business since there is no out-of-network coverage. That means they lower their prices and better coordinated care – and that lowers premiums.

Here’s the problem: these high-quality, low-cost plans are only available to large corporations who can “self-fund” their health insurance.

North Carolina government regulations are keeping individuals and small business from enjoying the same savings as our state’s biggest employers.

If you’re a small business whose number-one cost is healthcare, or an individual who can’t afford $12,000+ a year in premiums, wouldn’t you want the option of a health plan that could save you thousands a year?

If these new EPO products are good enough for big corporations, they are good enough for North Carolina’s small businesses and families.

And the only thing standing in the way of double-digit premium reductions are government regulations in Raleigh.

That needs to change.

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