Employees of the audit of health plan seeks Dan Kane The News & Observer, Raleigh, NC McClatchy-Tribune Regional News

March 5 - RALEIGH - The State Employees Association of NC Justice Center's Health Coalition today called on the access to an independent audit of the state of the health plan to administer the claims.

Both groups also want the state to submit the contract to open tender.

Legislation passed in 2005 allowed the health plan to circumvent the laws on open tender to select a business to a new Preferred Provider Organization option. The plan was then awarded the contract to Blue Cross and Blue Shield of North Carolina.

Another law has so far been interpreted to keep many details of the contract in an envelope.

On Saturday, The News & Observer reported that Blue Cross has received $ 97.5 million in fiscal year 2007-2008 for the administration of the PPO plan and a background that is eliminated at the end of this year . Blue Cross processed 9.4 million claims, which means that the company received more than $ 10 per claim.

Electronic Data Systems, the company handling applications for Medicaid, receiving 57 cents per request of the State.

An audit in 2007 also found that Blue Cross charged on average $ 4.88 per claim to manage a health plan for low-income children. At that time, EDS has averaged 41 cents per share under the Medicaid contract, the audit said.

"The enormous gap between what it costs to administer other health programs and what the Blue Cross for the expenses of the State Health Plan for a similar service raises serious questions," said Searing Adam, director of access to health care coalition. "To serve the State plan members and taxpayers, an independent audit and tendering process are needed."

Blue Cross officials maintain their contracts with the state require more work than EDS. The nonprofit, which is also the largest health insurer, also said that its profit margin on the PPO contract is less than a penny on the dollar. Health plan argue that the administrative costs, which include Blue Cross' contracts are in line with that of 12 other states.

Searing Séanc and Executive Director Dana Cope said an independent audit can determine if the State is surplus in the markets.

State legislative leaders have introduced a bill that has cost taxpayers about $ 580 billion out of the plan. The legislation also requires higher co-payments and deductibles to be paid by the plan of the approximately 667,000 state employees, teachers and pensioners.

Cope said that the plan of his relationship with Blue Cross needs more sun, since the recent discoveries in non-profit is paid $ 20 million more each year as part of the PPO plan had expected.

"Even if the buyers are required to supply office furniture, it is ridiculous that the $ 100 million annual health plan contract are not openly offer better services and prices," he said.

The bailout is expected to be reviewed at 1 pm Tuesday as part of a legislative committee that oversees the health plan.

dan.kane @ newsobserver.com or 919-829-4861
Copyright (c) 2009, The News & Observer, Raleigh, NC Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303 , Glenview, IL 60025, USA. March 5 - RALEIGH - The State Employees Association of NC Justice Center's Health Coalition today called on the access to an independent audit of the state of the health plan to administer the claims.