Florida Blue members facing loss of in-network rates for Memorial Healthcare System services

Florida Blue policyholders are being notified that Memorial Healthcare System may no longer be in the health insurer’s network.

The change would affect as many as 31,000 patients and take effect on Sept. 1. It would mean that Florida Blue policyholders — including individual members, members of employer-based plans, marketplace members, and Medicare Advantage members — would pay higher rates to access certain services and inpatient visits to Memorial’s medical facilities.

Also affected are members of  Anthem, Florida Blue Cross Blue Shield, Elevance, and other Blue Cross Blue Shield plans from other states.

“Memorial is currently negotiating a new agreement with Florida Blue to ensure continued in-network access for patients and fair reimbursement for the care we provide. The negotiations are part of a standard process that occurs when contracts are up for renewal,” Memorial said on its website.

All Memorial Healthcare System hospitals, physicians, urgent care centers, and specialty facilities, as well as all affiliated providers who participate through Memorial’s contracted network, would be affected. Memorial is a taxpayer-funded health system with six hospitals in southern Broward County.

“Please be advised that if we don’t reach an agreement by July 23, we will have to stop scheduling appointments for Florida Blue enrollees for services after September 1, 2025,” Memorial Healthcare System’s website said.

Florida Blue’s South Florida Market President David Wagner said the insurer and Memorial are negotiating a new multi-year contract and hope to reach an agreement before Sept. 1. He said Memorial wants a rate increase, and Florida Blue hopes to come to a reasonable agreement. “Conversations are going well,” he said. “We have a long history of partnership, but we still have a gap to narrow.”

By law, though, policyholders are being notified of the potential change in coverage. Florida Blue policyholders with Medicare plans already have received notification letters, and commercial plan holders will receive letters if an agreement is not reached by the end of the month.

Broward Health, the public health system in northern Broward County, remains in a contract impasse with Florida Blue. The same CEO now operates both Memorial and Broward Health. Florida Blue’s 18,000 policyholders lost in-network coverage at Broward Health on July 1.

Broward Health stated that it was being underpaid by Florida Blue, while the insurer has asserted that the health system is seeking an unreasonable rate hike.

Certain patients and circumstances will allow Florida Blue members to continue seeing their Broward Health team under in-network status “for a period of time,” Florida Blue said. State and federal protections called Continuity of Care cover pregnant women and others undergoing treatment for “serious and complex health conditions,” or in post-operative care following surgery, the insurer said.

Under federal law, patients are protected when it comes to emergency care. Emergency room and emergency services are always covered at in-network pricing, even at out-of-network facilities. This means Florida Blue members can still go to Broward Health — and Memorial — for emergency care, regardless of coverage.

Affected Broward Health patients have been advised to log into their Florida Blue member accounts to select other in-network hospitals, physicians or clinical sites.

Wagner at Florida Blue said negotiations are closer with Memorial than Broward Health. “We are still hoping we can come to fair and reasonable terms.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

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