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North Carolina Health Plan Activates Contingency as Duke–Aetna Talks Stall

Leaders warn conceding higher reimbursement rates could trigger premium increases across the state plan.

Overview

  • Duke Health’s contract with Aetna is set to lapse Oct. 20, and negotiations remain far apart, according to state officials.
  • The State Health Plan Board approved procuring a transition-services vendor and began transition-of-care outreach to at-risk patients.
  • Roughly 22,000–23,000 members list Duke as primary care and about 40,000 have filed Duke claims this year, underscoring the potential disruption.
  • State law guarantees continued in-network care for cancer and maternity patients, with about 2,800 members prioritized for paperwork to maintain treatment.
  • The board’s contingency resolution passed with six votes in favor and two abstentions, as Duke cites four years without a rate increase and Aetna argues Duke’s request is unreasonable in a high-cost market.