By admin 
RALEIGH, N.C. (WNCN) — Members of the North Carolina State Health Plan’s administrators made a decision that impacted thousands of WakeMed patients in the Triangle on Wednesday.
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The plan’s administrators announced that Duke Health would be made an “access provider” under the plan’s new tiered system that is being implemented in 2027. With Duke being selected for the access tier, patients using Duke Health services will see the same or better services. This also means many WakeMed patients on the plan will have to pay more, as the state said those services will fall into the “non-preferred” tier.
“WakeMed is an excellent facility, and we continue to value their services, such as their emergency department and their OB platform (which they currently partner with Duke Health on),” NC State Health Plan Executive Administrator Tom Friedman said. “But given the savings to the Plan and the human impact, we believe Duke Health is the right access partner for the State Health Plan.”
WakeMed said the decision is damaging to both the facilities and the thousands of people who use them for care.
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“It will have serious financial consequences to WakeMed, as a not-for-profit, safety-net health care system, and for the community that has relied on us for more than 65 years,” WakeMed said in a statement.
Health plan changes
At the heart of the plan is a new multi-tier provider network, which is designed to lower out-of-pocket costs by steering members to its preferred providers.
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- Preferred providers, offering members the lowest copays, deductibles and out-of-pocket costs.
- Access providers, where costs would generally remain similar to today’s benefit structure while maintaining access in rural communities and areas with fewer provider options.
- Non-preferred providers, where members would pay significantly more out of pocket.
- Out-of-network providers, where officials have said members would see relatively little change because of the State Health Plan’s broad national network through Aetna.
The premium, benefit and provider network changes will take effect in 2027.