Florida Blue, VitalMD reach contract agreement ahead of deadline

by | Apr 25, 2023

  • Florida Blue and VitalMD reached a multi-year contract agreement, ensuring that VitalMD remains under the Florida Blue network for three years.
  • The agreement includes individual and employer-provided commercial plans and Medicare Advantage PPO health plans but did not extend Florida Blue’s Medicare Advantage HMO contract.
  • VitalMD patients were warned last month that its coverage under Florida Blue was at risk, with the insurance provider claiming that the healthcare specialists demanded above-market rate increases.

Florida Blue and VitalMD have announced that they successfully reached a multi-year contract agreement in advance of an impending negotiations deadline that would have resulted in the healthcare provider’s exclusion from Florida Blue’s network of coverage.

With the agreement, VitalMD, which owns more than 300 care centers primarily serving South Florida but extending to thirteen counties throughout the state, will remain under the Florida Blue umbrella for three years.

“We have reached a multi-year agreement with VitalMD,” said Florida Blue. “This agreement includes individual and employer-provided commercial plans and Medicare Advantage PPO health plans. These members will continue to have their doctors and clinicians in our network.”

The extension, however, did not renew Florida Blue’s Medicare Advantage contract and is considered out-of-network at the time of this writing.

“Please note that Florida Blue’s Medicare Advantage HMO contract with VitalMD is not being renewed and VitalMD is an out-of-network provider for all Florida Blue Medicare HMO products,” the company said.

Last month, VitalMD patients were notified that its coverage under Florida Blue was in jeopardy, and unless an agreement was reached, would expire by mid-April, as first reported by The Sun Sentinel in March. The provider warned that more than 41,000 patients could potentially lose their insurance coverage.

In a prior notice, Florida Blue claimed that VitalMD notified of its intent to renegotiate or terminate its current agreement and “demand[ed] above market rate increases,” which it said would result in significant cost increases.

“The high-rate increases demanded by VitalMD would greatly drive up the cost of health care and insurance for our customers and the communities we both serve. In contrast, we are confident the contract terms we proposed are fair and competitive and are hopeful VitalMD decides to remain in our network.”

The insurance provider gave a similar statement last October when it engaged in contract negotiation with BayCare, which serves as one of the largest health providers in Southwest Florida. According to a Florida Blue media alert, BayCare initiated discussions, demanding a “double-digit percent increase for hospital services” and a “two-to-three-fold increase for its doctors, imaging, and accessory services.”

BayCare responded by claiming that inflation-driven labor and supply prices have increased without a commensurate share of revenue being passed on to providers and practitioners.

Similar to its negotiations with VitalMD, Florida Blue was able to secure a multi-year contract with BayCare just several days before the deadline through a last-minute agreement.


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