RALEIGH, N.C. — Twenty North Carolina lawmakers are questioning political advocacy by Blue Cross and Blue Shield of North Carolina.

The legislators on Tuesday asked Attorney General Roy Cooper and Insurance Commissioner Wayne Goodwin to examine automated phone calls and mailers placed by the state's largest health insurer.

"As a corporation that claims to deliver innovative health care products and services to its members, Blue Cross Blue Shield appears to be engaging in a blatant political campaign utilizing the premiums paid by their customers," the letter said. "Even if there is no apparent violation of existing statutes, we think this is bad public policy that deserves further scrutiny."

Blue Cross sent fliers to selected people across the state, asking them to contact U.S. Sen. Kay Hagan to ask that she oppose the creation of a government-run health insurance plan that would compete with private plans.

"They're using our health care dollars to fund this campaign, which is just unacceptable. It's contrary to what a lot of policyholders want," said Adam Linker, a policy analyst with the North Carolina Health Access Coaltion, an organization that backs increased health care coverage for uninsured people.

State Rep. Pricey Harrison, D-Guilford, said she heard from numerous constituents who were likewise upset about the campaign, so she spearheaded the request for investigations by the Department of Justice and the Department of Insurance.

"I think it's the particular method that they've chosen. I think it's this sort of heavy-handed tactics of scaring policyholders," Harrison said.

Lawmakers said they think Blue Cross violated rules for the Do Not Call Registry in making automated calls, and they questioned the company's advocacy effort, noting that it has had a tax-preferred status for decades.

"These robo-calls had nothing to do with providing care to patients but were instead used to advocate a specific political stance," the letter said. "While we are strongly committed to the First Amendment, we do not believe that policy holders intended for their relationship with Blue Cross to be used in this manner."

The Attorney General's Office already has contacted Blue Cross officials, and company spokesman Lew Borman said the insurer is cooperating with the investigation.

Borman declined to comment on whether the calls and fliers violated any regulations, saying only that Blue Cross must be involved in the health care reform debate.

"We feel like we had the right, and in many ways the responsibility, to communicate with North Carolinians," he said.

Blue Cross leaders plan to continue speaking out on health care reform, he said, but there are no plans to call customers directly again.