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Treadmill trouble: A mother’s battle for special needs coverage in North Carolina

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Treadmill trouble: A mother’s battle for special needs coverage in North Carolina


CHARLOTTE, N.C. (WBTV) – A mom calling for change after an exhausting battle to get her particular wants daughter a treadmill. Our WBTV Investigates Group is digging for solutions about what went mistaken with the approval course of for her insurance coverage, the brand new managed care group in Mecklenburg County.

The pandemic wasn’t sort to Rachelle Phillipe, who goes by Chelley, in keeping with her mom Marie Phillipe.

“She was unable to exit in the neighborhood as a result of she was not as lively as she was previous to COVID she gained weight,” Marie Phillipe stated

Chelley is particular wants and is on the NC Improvements Waiver. It’s serviced by Mecklenburg County’s new managed care group Alliance Well being, which took over for Cardinal Improvements.

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“She will get caretakers that principally assist me take care of her throughout the day,” Phillipe stated.

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“She’s obtained individuals who truly advocate for her.”

However the weight was a little bit of an issue. With some assist, Phillipe discovered part of the coverage that may give Rachelle $2,000 to purchase a treadmill.

“It shouldn’t have been an issue,” Phillipe stated.

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Phillipe was denied twice, regardless that she says her claims happy all the necessities within the coverage, together with a physician’s observe prescribing the treadmill.

“They stored giving me different insurance policies which I knew didn’t apply and I stated if you happen to guys simply give me a name, we are able to talk about this. I pleaded for individuals to name me, and so they refused,” Phillipe stated.

However Phillipe made calls and emails, together with to Mecklenburg’s Assistant County Supervisor, Anthony Trotman. She by no means heard again however the ball obtained rolling and Rachelle obtained the approval to purchase the treadmill.

However curiously, they requested her to discover a cheaper possibility, regardless that that’s not talked about within the coverage.

“They instructed me to seek out one thing that was $1,000, which I don’t know why would that be even crucial. I imply, it didn’t make any sense to me,” Phillipe stated.

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Phillipe should undergo Alliance’s “Utilization Administration” to get approval. And in keeping with exterior high quality opinions executed by the Carolinas Heart for Medical Excellence, Alliance has “weaknesses” 12 months after 12 months in that class. That features deficiencies in monitoring and evaluating sure purchasers and inconsistencies in procedures and handbooks.

As a result of Phillipe stored making calls and sending emails, NC Medicaid required new coaching for Alliance and each LME/MCO to familiarize with the Improvements Waiver insurance policies.

However Phillipe stated she’s sharing her story so different households know to maintain combating and to succeed in out for assist.

“I worry for individuals who actually don’t have a voice on this or don’t know precisely what to do to advocate for his or her for his or her youngsters,” Phillipe stated.

“I do wish to make noise in order that different households can hear these tales and that they know don’t surrender simply because they are saying no, there are alternatives on the market.”

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WBTV reached out to Alliance. In an electronic mail, they refused to reply most of our questions citing HIPAA however did reply our questions on what they’re doing to forestall this once more writing – “All Utilization Administration employees members are accountable for collaborating in Inter-Rater Reliability actions and practices. The State supplies technical help and help concerning medical protection insurance policies when wanted or requested.”

In case you’re combating discovering particular wants help in North Carolina attain out to the WBTV Investigates Group and share your story. You’ll be able to electronic mail us at investigates@wbtv.com.



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Risant Health plans to acquire North Carolina hospital system

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Risant Health plans to acquire North Carolina hospital system


Risant Health, the new organization founded by Kaiser Permanente, is planning to add its second hospital system.

Risant has announced plans to acquire Cone Health, based in Greensboro, North Carolina. Cone includes four acute care hospitals, a behavioral health facility, a health plan, and an accountable care organization caring for nearly 200,000 patients. Risant and Cone announced the plans late last week.

The move comes just a couple of months after Risant announced it had completed the acquisition of Geisinger Health in Pennsylvania.

In announcing its plans, Risant Health CEO Dr. Jaewon Ryu lauded Cone Health’s commitment to value-based care.

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“Cone Health’s impressive work for decades in moving value-based care forward aligns so well with Risant Health’s vision for the future of healthcare,” Ryu said in a statement. “Their longstanding success and deep commitment to providing high-quality care to North Carolina communities make them an ideal fit to become a part of Risant Health.”

“We will work together to share our industry-leading expertise and innovation to expand access to value-based care to more people in the communities we serve,” Ryu said.

The organizations will need to secure the approval of regulators to complete the deal.

Under the plans, Cone Health will operate independently but will take advantage of resources and support from Risant Health.

Cone Health will retain its name and brand identity, along with its current leadership team and board of directors, the organizations said. Cone employs 13,000 workers and has 1,800 physicians.

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Dr. Mary Jo Cagle, president and CEO of Cone Health, said joining Risant Health “presents a unique opportunity to shape the future of healthcare in the Triad, the state, and across the nation.”

“As part of Risant Health, Cone Health will build upon its long track record of success making evidence-based healthcare more accessible and affordable for more people. The people across the Triad will be among the first to benefit,” she said.

Risant has said its goal is to acquire community-based hospital systems focused on providing value-based care.

A nonprofit organization, Risant is based in Washington, D.C. Greg A. Adams, Kaiser Permanente’s CEO, is the chairman of Risant Health’s board and stressed the need for moving away from fee-for-service care.

“Risant Health has put a stake in the ground that care focused on evidence, equity, population health and improved outcomes must be the future of healthcare,” Adams said in a statement. “Models like that of Kaiser Permanente, Cone Health and Geisinger will help make that possible.”

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After completing its acquisition of Geisinger in the spring, Risant reiterated its plans to acquire “4 to 5 additional leading community-based health systems over the next 4 to 5 years.”

Cone Health serves an area with strong growth and benefits from a favorable payer mix, with Medicaid and self-pay accounting for less than a fifth of its 2022 revenue, according to Fitch Ratings. Fitch has given Cone Health a stable outlook. Cone Health’s Triad market also boasts some big employers, and Toyota recently announced plans to invest nearly $8 billion and add nearly 3,000 jobs to a battery production plant.

Mae Douglas, chair of the Cone Health board of trustees, said the North Carolina system’s leadership weighed the prospect of joining Risant for more than a year.

“Through this agreement, we will continue to improve upon our long tradition of providing health and well-being to those we serve,” Douglas said in a statement.

Cone’s flagship hospital, Moses H. Cone Memorial Hospital in Greensboro is a teaching hospital with 628 beds. Alamance Regional Medical Center in Burlington has 238 beds, Wesley Long Hospital has 175 beds, and Annie Penn Hospital offers 110 acute care beds.

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Kaiser Foundation Hospitals, a division of Kaiser Permanente, is designating up to $5 billion “to support core Risant Health capabilities, technologies, tools, and future investments,” according to financial documents filed last year.

Geisinger, which operates 10 hospital campuses and 134 healthcare sites, has kept its identity since being acquired by Risant Health.

Ryu served as president and CEO of Geisinger Health for five years before becoming the first CEO of Risant Health. Geisinger named Terry Gilliland, MD, as its new president and CEO.



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NC Senate gives initial approval to bill affecting mail-in voting, AI and local elections

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NC Senate gives initial approval to bill affecting mail-in voting, AI and local elections


RALEIGH, N.C. (WNCN) – The state Senate gave initial approval to a bill Tuesday with significant changes to the state’s elections, as Democrats accused Republicans of a “blatant power grab” when it comes to local elections.

The bill has a variety of provisions that also affect mail-in voting and the use of artificial intelligence in political ads.

The passed its second reading on 26-18 party-line vote. It’ll require an additional vote before it goes to the House.  

The legislation aims to address the use of generative AI to deceive or mislead voters by requiring disclosure of the use of that technology in political advertisements. The proliferation of “deepfakes” and deceptive videos is a chief concern to state election officials.

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Karen Brinson Bell, executive director of the NC State Board of Elections, recently said she worries about someone using her voice to create false messaging about the date of the election or other key information.

“I don’t know that there’s any state law that can 100 percent address that, but we need to try. We need to try to figure out a way to keep this kind of deceptive information from affecting our elections,” said Ann Webb, policy director of Common Cause North Carolina

The disclosure would be required when an ad is created entirely or in part with generative AI and: depicts a real person doing something that didn’t actually happen; was created to injure a candidate or deceive voters regarding a ballot issue; or provides false or misleading information to a voter.

Webb said she thinks the provision also should apply to digital ads.

Failing to comply would be considered a misdemeanor. That part of the law would go into effect July 1. However, Sen. Warren Daniel (R-Burke) said conversations are still underway with Republicans in the House, so the General Assembly may not take final action on the legislation until next year.  

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Republicans also want to move forward with requiring the state conduct signature matching of mail-in ballots to try to verify people are who they say they are.

They previously authorized a 10-county pilot study, which still is not done. NC State Board of Elections spokesman Pat Gannon said Tuesday the agency has contracted with BizTech Solutions to work with the counties on the pilot.

The technology aims to match someone’s signature on their absentee ballot envelope with the signature on file with the state.

Sen. Daniel (R-Burke) said even though the results of that pilot are still not available, he still wants to move forward with implementation. It would not take effect until 2025, meaning the first use would occur in lower-turnout local elections that year.

“Rather than kind of wait on the bureaucratic churn of that process, we’re going to go ahead and authorize that to be done in 2025 and beyond,” he said. “Here we are this long in the future waiting on the data from the Board of Elections. Probably most of us thought this would be implemented for this election.”

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North Carolina already requires people to either have two witnesses attest that someone is indeed the person who filled out a mail-in ballot or a notary public.

Sen. Dan Blue (D-Wake) questioned the need for the additional verification. He asked, “And you’re letting a machine that’s unproven basically say that that notary lied?”

Democrats objected to another part of the bill that would give the General Assembly greater ability to determine how county and city leaders are elected.

“It is one of the more blatant power grabs that we’ve seen,” said Sen. Julie Mayfield (D-Buncombe), adding that she thinks Republicans are likely to target heavily Democratic communities to potentially redraw local districts.

Sen. Daniel said Democrats aren’t being consistent in their arguments for proportional representation.

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The bill now goes to the House. Senate leaders say they don’t plan to hold any more voting sessions after this week regardless of whether Republicans can reach a compromise on issues like changes to the state budget.



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BJ’s Wholesale Plans New Clubs In New Jersey, North Carolina

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BJ’s Wholesale Plans New Clubs In New Jersey, North Carolina


BJ’s Wholesale Club is expanding in New Jersey and North Carolina.

BJ’s Wholesale Club is expanding in the east with new stores in the works in New Jersey and North Carolina.

Slated to open in early 2025, the warehouse club will open its 25th club in New Jersey’s Hanover Township. Its 10th North Carolina store will be located in Southern Pines.

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“We are excited to deliver the unbeatable value our membership offers to even more families in New Jersey and North Carolina,” said Bill Werner, executive vice president of Strategy and Development at BJ’s Wholesale Club. “As we continue to expand our footprint along the East Coast and beyond, we look forward to helping more families save up to 25 percent off grocery store prices every day.”



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