State Health Plan and Atrium dispute 2027 provider-network decision
The State Health Plan says Atrium did not participate in its contracting process, while negotiations remain possible before the new network takes effect.
RALEIGH — The North Carolina State Health Plan has publicly disputed Atrium Health’s account of how the hospital system was left outside the plan’s preferred provider network for 2027.
In a Friday statement, the State Health Plan said Atrium did not submit a proposal during the plan’s contracting process despite conversations between state officials and hospital-system leaders.
The dispute affects a health plan covering approximately 750,000 teachers, state employees, retirees and dependents.
The State Health Plan Board of Trustees approved a tiered provider-network strategy and benefit structure in March. Under that structure, providers offering the plan more favorable prices may receive preferred placement, resulting in lower costs for members who use them.
The plan said it met with hospital systems in August and September 2025 to discuss its financial condition and its intended partnership with Lantern, the company assisting with the provider network.
According to the plan’s timeline, Executive Administrator Tom Friedman visited Atrium in November, and Treasurer Brad Briner spoke with Atrium’s chief executive and chief financial officers in May and June.
State officials said Atrium did not make an offer to participate as a preferred partner. The plan contrasted that response with Duke Health, which was added as an access provider after reaching an agreement with the state.
The State Health Plan accused Atrium of issuing a misleading public statement about the amount of engagement between the two organizations. Atrium’s complete statement was not included in the state release, making the Treasurer’s response only one side of the public dispute.
The plan said it remains willing to continue discussions and scheduled another meeting after receiving communication from Atrium.
Atrium facilities are not necessarily unavailable to plan members under the tiered arrangement, but members could face higher out-of-pocket costs when using providers outside the preferred tier. Exact costs will depend on the final 2027 benefit design and provider participation.
The dispute adds uncertainty for State Health Plan members in areas where Atrium operates major hospitals, medical practices and specialty-care facilities. Members should review final network listings and cost information during enrollment rather than assuming their current provider’s status will remain unchanged.
Editor’s note: This article was drafted with the assistance of artificial intelligence and was reviewed and fact-checked by a member of the NC Political News editorial team before publication.
