Co-pay-free doctor’s visits coming for some state workers – but only at certain doctors

State Treasurer Dale Folwell wants to add more health care providers to the State Health Plan’s “Clear Pricing Project,” while adding incentives for Health Plan participants to use Clear Pricing Project providers.

Folwell’s continued efforts to promote the new payment model, which ties reimbursement rates for health care providers to Medicare rates, has been controversial and has drawn fire from his Democratic opponent. The State Health Plan is the health insurance benefit that serves hundreds of thousands of state employees, teachers, state retirees and their families.

After major hospital systems refused to join the new payment model, saying the reduced reimbursement rates would force them to cut services, Folwell relented last year. State Health Plan users this year have been able to continue to use providers in Blue Cross and Blue Shield of North Carolina’s network as well as Clear Pricing Project providers.

Those options will remain in 2021 for State Health Plan users, a Folwell spokesman confirmed, but some co-pays will change to encourage users to select Clear Pricing Project providers.

Folwell announced this week that there will be no co-pay for primary care visits to those providers (currently the co-pay is up to $45), with co-pays as low as $40 for specialists, down from $80-94 under this year’s plan.

Folwell also announced a new sign-up period between Sept. 15 and Oct. 15 for more providers to join the system.

“We’re excited to offer these Clear Pricing Project cost savings to our hardworking plan members and their families,” Folwell said in a news release. “This is a perfect opportunity for new providers to join the N.C. State Health Plan Network as we lower healthcare costs and encourage members to use these providers.”

He argues that the initiative makes health care costs more transparent and saves the plan money.

The Clear Pricing Project is poised to become a key issue in the state treasurer’s race, and a defeat for Folwell in November could spell the end of the initiative.

His Democratic opponent, Duke University professor Ronnie Chatterji, blasted Folwell’s latest announcement in a news release.

“Instead of introducing the same plan that failed just a year ago, I would work to expand Medicaid and align State Health Plan payments with value not volume,” Chatterji said. “My approach will ensure more North Carolinians have access to affordable healthcare and that we receive the highest quality care. As state treasurer, my strategy would be data-driven and hold hospitals accountable for healthcare outcomes.”

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