Blue Cross Blue Shield of North Carolina is a 10.7 billion dollar organization offering health insurance in the state of North Carolina. Because BCBSNC commands a whopping 97% market share of North Carolina’s health insurance market, the vast majority of addiction treatment patients in North Carolina carry insurance coverage with BCBSNC.
While it is technically a non-profit organization, BCBSNC's annual revenues have jumped astronomically since the pandemic began. As with many insurance payers, even those that claim non-profit status, BCBSNC executives are regularly given large bonuses while premiums continue to rise.
What Characterizes a Typical Blue Cross Blue Shield of North Carolina Member? Do They Often Seek Addiction Treatment Care?
The short answer to the second question is yes, BCBSNC members often seek addiction treatment care. 1 in 5 North Carolinians will experience a need for behavioral health care in any given year, and BCBSNC members - who make up 97% of insured people in North Carolina - are no exception.
BCBSNC offers both public, employer and private pay memberships. Because North Carolina recently made the switch to managed care for its public health insurance option, five private MCOs (or Managed Care Organizations) now run the Medicaid program in North Carolina. BlueCross BlueShield of North Carolina manages the biggest MCO in North Carolina, called HealthyBlue.
In other words, BCBSNC members come in every demographic, from affluent to working class, so it’s difficult to generalize about their identifying attributes. Again, this is because the vast majority of insured people in North Carolina carry BCBSNC insurance.
Does Blue Cross Blue Shield of North Carolina’s Have Good Behavioral Health and Addiction Treatment Coverage?
Blue Cross Blue Shield of North Carolina is subject to the same behavioral health and mental health parity laws that most large payers are subject to. That means that they are required to cover substance use disorder as equally as they cover any other disease. However, North Carolina recently received an “F” rating from NAMI North Carolina on its behavioral health parity. Because BCBSNC commands such a large market share, it is easy to extrapolate this data to BCBSNC’s parity performance in general.
There are many ways that insurance payers dodge parity in mental health and behavioral health coverage.
For example, Blue Cross Blue Shield of North Carolina has been accused of using a variety of tactics to pressure clinicians into accepting lower in-network rates.
Some clues about how BCBSNC is achieving this goal with addiction treatment providers can be found in a study on behavioral health disparities in health coverage in North Carolina done by ParityTrack.
The report shows that more patients are forced to seek out-of-network care for behavioral health in North Carolina than in the United States as a whole. The same difference is not seen for other medical care in the state - just behavioral healthcare.
The study also shows that provider reimbursements for behavioral health care are shockingly low in North Carolina, creating a disincentive for providers to even provide this type of care in the state at all. In fact, reimbursement rates for PCPs visits in North Carolina are 50% higher than behavioral health care visits.
It’s also reported that nearly 30% of people in North Carolina report that they have an “unmet need” for behavioral healthcare, such as counseling or therapy. Given that BCBSNC commands such a significant portion of the membership base in North Carolina, it’s easy to see how they are at least partially responsible for these inequities in addiction treatment.
What Does This Mean for Average Length of Stay Per Level of Care for Addiction Treatment at BCBSNC?
Unfortunately, there is no public data available about how long the average inpatient, outpatient IOP addiction treatment care episode is authorized for at BCBSNC. The state has neglected to research this information and Blue Cross Blue Shield of North Carolina declines to speak even generally on this issue on their member-facing opioid epidemic and behavioral health landing pages.
It’s also unsurprising that BCBSNC also declined to comment on this issue in their Corporate Medical Policy on Residential Treatment.
However, given what we know about BCBSNC’s poor track record with behavioral health parity, we can assume that their average length of stay per level of care for addiction treatment is below industry standard and likely below the national averages, as well.
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