RALEIGH, N.C. — Most Atrium Health hospitals and doctors’ offices will be moved to the out-of-network tier of the State Health Plan starting Jan. 1, 2027, North Carolina Treasurer Brad Briner announced Wednesday in Raleigh, N.C., deepening a monthslong fight over what the plan pays for care.
The exception is a set of Atrium sites already designated at the plan’s access level under an earlier agreement. Everything else in the system shifts to the lowest tier.
The move came one day after a judge refused to halt Atrium’s Affordability Protection Program, which the company rolled out last week to cover the higher out-of-pocket costs state workers would face under the plan’s new tiers. Briner had sued to stop it, arguing the subsidy interfered with the plan because the plan itself would still be paying Atrium’s higher rates. The judge sided with Atrium at the initial hearing.
Briner, who also chairs the plan’s board of trustees, said members who keep seeing Atrium providers should not pay more as long as the company honors its subsidy promise, describing the change as accounting that happens out of view of patients. He estimated the shift would keep hundreds of millions of dollars in the plan and said that, without it, the cost of Atrium’s rates could approach a quarter of a billion dollars, money the plan cannot cover.
Coverage through the plan reaches more than 750,000 people, including state workers, retirees and their families, and open enrollment started Monday. It is running a deficit in the hundreds of millions, and Briner has already raised premiums and built a four-tier provider network that rewards members for using lower-cost providers.
The dispute lands close to home for the Triangle. Atrium, the largest health care chain in the state, has hospitals in Charlotte, Winston-Salem and elsewhere and is working toward a merger with Raleigh-based WakeMed that would give it a foothold here as a rival to UNC Health and Duke Health.
Neither Atrium nor Advocate Health, the company that owns it, had commented on the decision by Wednesday evening.
Filed under: Greer SC Health News
