Advantage, Urgent Care? Plans Are Already Passing ACA Losses Off on Members

Urgent care operators may have new leverage when negotiating reimbursements or appealing to cash-paying patients in North Carolina. Blue Cross and Blue Shield of North Carolina (BCBSNC) says it has lost $280 million by covering residents under the Affordable Care Act (ACA, or “Obamacare”)—and in response, it’s filing for a 2017 rate increase of 18.8%. BCBSNC says higher-than-expected ED visits and orthopedic treatments (the cost of which could be greatly diminished if appropriate patients visited urgent care instead of the ED) are among the biggest culprits. As reported here previously, decreased competition caused by an exodus of insurers who say they can’t afford the losses associated with ACA exchanges has been expected to drive prices up, as seen in in North Carolina. In addition to BCBSNC, Aetna is seeking a 23% increase in the Tar Heel State.