Florida Blue, Broward Health hit standstill over costs. What it means for patients

Thousands of people who have health insurance through Florida Blue may find themselves paying a heftier bill the next time they seek care at Broward Health, one of three public hospital systems in South Florida and one of the largest in the country.

As of July 1, Broward Health is no longer an in-network provider for Florida Blue, ending a decades-long agreement with one of the largest insurers in the state, at least for now.

The two organizations are blaming each other as to why rate negotiations fell through. Broward Health is accusing Florida Blue of underpaying it compared to other similar South Florida health providers and insurers. Florida Blue is accusing Broward Health of wanting too much money.

Negotiations are still ongoing. But, since the previous three-year contract between the two has expired, that means Broward Health patients who have insurance through Florida Blue may see their costs for care go up until a deal is made.

Here’s what to know.

How does the Broward Health, Florida Blue standstill affect patients?

Patients who have insurance through Florida Blue may need to find new doctors who are in the Florida Blue network to get cheaper — or covered — medical care. If not, they might find themselves paying a heftier bill for primary and specialty care at Broward Health, which is now an out-of-network provider for Florida Blue members.

As of July 1, all Broward Health services, facilities, clinics and physicians will be impacted by the standstill between Broward Health and Florida Blue, which was previously known as Blue Cross & Blue Shield of Florida. This includes Broward Health primary, specialty, surgical, therapy, hospital and urgent care services.

Broward Health said all patients who are impacted by the change have been notified. Florida Blue said it notified about 18,000 members in May about the situation, including patients who had received care at Broward Health in the last six months or who have a Broward Health primary care doctor.

Patients affected by the stalled negotiations include those who have coverage under Florida Blue through employer-sponsored health plans, the Affordable Care Act marketplace and Medicare Advantage plans, according to Broward Health and Florida Blue. Health Options and New Directions Behavioral Health plans are also under the Florida Blue umbrella.

The hospital system said Medicare Supplemental and Medigap plans will not be impacted.

Does it affect care with private physicians?

It depends. Broward Health spokesperson Jennifer Smith told the Miami Herald that the negotiation standstill means the care provided at Broward Health facilities and by physicians employed by Broward Health will be considered out-of-network for Florida Blue members, at least for now, until an agreement is finalized.

Broward Health, which mainly serves central and northern Broward County, is one of the 10 largest public health systems in the country, with five hospitals and more than 50 health centers and physician practices. It’s one of two public hospital systems in Broward County, the other being Memorial Healthcare System, which mainly serves southern Broward.

Physicians with private practices who are renting office space at a Broward Health location or are credentialed to provide medical services at a Broward Health hospital might still offer in-network care for Florida Blue members. But care coverage may vary.

Care provided at your doctor’s office, for example, might still be covered by Florida Blue, but the elective surgery your doctor scheduled at Broward Health may now be considered out-of-network.

Patients should contact their doctor’s office and Florida Blue to confirm what type of care is covered and where.

What about the ER and other emergency services?

Florida Blue members can still go to Broward Health for emergency care, as “ER and emergency services are always covered at in-network cost share, even at out-of-network facilities,” according to Florida Blue.

What if I’m pregnant, undergoing treatment or just underwent surgery?

The health insurer said some patients may still be able to continue getting in-network care at Broward Health for a certain period of time under federal and state protections for continuity of care. This includes people who are pregnant or who are “undergoing active treatment for serious and complex health conditions, or in post-operative care following surgery,” according to Florida Blue.

What are Broward Health and Florida Blue trying to negotiate?

Broward Health and Florida Blue are trying to negotiate reimbursement rates for treating patients. Both are pointing the finger at the other as to why negotiations have stalled, though they both say they’re committed to reaching a deal.

Florida Blue said Broward Health is asking for a 60% rate increase over the next three years, a request it says is “excessive and unsustainable, and would burden our community with much higher health care costs.” The insurer estimates the rate increase would result in more than $150 million in higher health care costs for Florida Blue members.

It also alleges that Broward Health wants the ability to set its own prices, a move it says would give the hospital network the “ability to raise prices at any time for medical treatments and drugs, based on their hospital billed charges, without any warning or agreement from Florida Blue. This would lead to ‘surprise bills’ for patients.”

Smith, the Broward Health spokesperson, disputed Florida Blue’s allegations and said Broward Health never discussed having the ability to change prices at any time. She also reiterated that Florida Blue has “historically undervalued” the care the hospital system provides to patients.

The hospital system, in an emailed statement to the Herald, said its discussions with the health insurer were about “fairness.” Broward Health says it’s asking Florida Blue to reimburse its team at levels “comparable” to what it reimburses other South Florida health care providers and the rates provided by other insurance companies for the same services.

Broward Health is “doing everything we can to protect important care choice and access for our patients,” the statement reads.

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