Amid BayCare’s threat to leave Florida Blue, thousands of Floridians could be forced to pay out-of-pocket for healthcare

by | Sep 6, 2022

 

  • Florida Blue, one of the state’s largest health insurance providers, and BayCare, Southwest Florida’s leading health provider, are locked in a contract negotiation battle that could result in BayCare’s exit from Florida Blue’s coverage network 
  • Florida Blue claims that BayCare is demanding an increase in the amount they are paid to care for Florida Blue customers in excess of $80 million 
  • More than 85,000 Florida Blue customers who received care from the BayCare Health System in the last six months will receive notices in the mail this week regarding the potential departure 
  • Should the two sides fail to reach an agreement, BayCare will exit Florida Blue’s network on Oct. 1. 

Florida Blue and Baycare are locked into a stalemate over contract negotiations. If the two parties cannot reach an agreement, all BayCare hospitals, physicians, and facilities will be classified out-of-network for anybody covered by Florida Blue beginning Oct. 1.

According to a Florida Blue media alert, BayCare began discussions, demanding a double-digit percent increase for hospital services and a two-to-three-fold increase for its doctors, imaging, and accessory services.

This, according to the insurer, would result in increased service and premium expenses. More than 85,000 Florida Blue customers who have received care from the BayCare Health System in the previous six months will receive notes in the mail this week advising them that BayCare may opt out of Florida Blue’s networks.

“Unfortunately, BayCare is asking for an extremely large increase in the amount they are paid to care for our members. The total increases demanded by BayCare Health System are an excess of $80 million that Tampa Bay and Polk County members and employers would have to pay each year – in addition to their current premiums and out-of-pocket costs. We cannot possibly put this excessive burden on the people and businesses in Pinellas, Pasco, Hillsborough, and Polk counties,” Florida Blue stated in a release.

Florida Blue additionally stated that it is attempting to work with BayCare to develop continuity-of-care processes to help minimize potential disruption for members in the middle of treatment. Continuity of Care would allow eligible members receiving active treatment from BayCare Health System to continue their treatment at the same out-of-pocket costs, even if BayCare exits Florida Blue’s networks.

However, BayCare claims that Florida Blue has been unwilling to come to a fair and reasonable agreement, doubling down on the threat to pull out of Florida Blue’s network of coverage.

“In recent months, BayCare has been working with Florida Blue to reach a new, fair network agreement that puts our patients’ needs first and ensures your continued in-network access to BayCare hospitals, our laboratory services, and BayCare Medical Group physicians,” A letter penned by BayCare reads. “Unfortunately, Florida Blue has so far been unwilling to reach an agreement that would guarantee we can sustain the services that patients like you depend on from the physicians you know and trust.”

BayCare is a leading health provider across Tampa Bay and Southwest Florida, treating hundreds of thousands of patients in 2021 as well as performing close to 90,000 surgeries.

Should an agreement fail to be reached, Floridians that have only BayCare facilities nearby could be forced to pay out-of-pocket costs for basic health services.

State Rep. Mike Beltran last week wrote a letter to the leaders of both companies, lambasting the public feud.

“None of your rhetoric resonates with me or my constituents. District 57 is a community of working families who wish to maintain useable coverage at a fair price,” wrote Beltran. “Much of the Tallahassee agenda, by contrast, is consumed with squabbles between humungous companies attempting to gain an advantage in the marketplace. Imagine my disappointment to return to my constituents to find the same occurring at home.”

Though negotiations are ongoing, there is no immediate sign of an immediate resolution being reached.

4 Comments

  1. Kevin Donnelly, MD

    This will be resolved in the “11th hour.” When negotiating with insurance companies, this is how they “negotiate.”

    Reply
  2. dmmorrison

    Not directly related, but this might be a good time for Florida to accept Medicaid expansion. That would greatly help 800,000 struggling Floridians.

    Reply
  3. HowRd Edmondson

    Been a Baycare patient for over 13 yearsI & my insurance co. & Medicare have paid in excess of 500k for Baycare services. No settlement, I’m gone.

    Reply
  4. Gerald Ponkey

    Doing the math, it works out to $941.00/person which each patient has to fork over each year. With everything else going up, the average person will not be able to afford healthcare. In the end, most of us will leave Baycare and go elsewhere.

    Reply

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