Florida Blue members lose in-network rates for Broward Health services

Florida Blue policyholders have been notified that due to a contract impasse, Broward Health is no longer in the health insurer’s network.

The change took effect on July 1, ending, at least temporarily, a contract that has been in place more than 30 years.

That means that Florida Blue policyholders — including individual members, members of employer-based plans, marketplace members and Medicare Advantage members — must now pay higher rates to access certain services and in-patient visits to Broward Health facilities.

Also affected are members of Florida Blue’s Health Options Inc. and New Direction Behavioral Health plans, plus other insurers affiliated with the national Blue Cross Blue Shield network, known as “Blue card” members, a Florida Blue spokesman said.

Medicare Supplemental and Medicap plans are not impacted, according to information on Broward Health’s website.

Both sides said they hoped the impasse would be resolved.

The change follows what both sides said were months of negotiations that failed to result in a new contract.

“Broward Health, a cornerstone of health care in South Florida, has been a partner of Florida Blue for decades, and the two organizations have always reached an agreement without any disruption for members,” Florida Blue said in a news release.

The statement continued, “Florida Blue’s goal from the start has been to keep Broward Health in network — to maintain the relationship between doctors and members while protecting members from significant and unnecessary health care cost increases.”

Florida Blue said that the 18,000 members were notified in May that the change would take effect if an agreement wasn’t reached by July 1. Members who were notified, the insurer said, included patients who have used a Broward Health facility over the past six months or who have a Broward health primary care doctor.

The insurer said that Broward Health is seeking a rate increase that is “significantly higher” than its previous request. “They’re demanding 10 times what they asked for — and Florida Blue agreed to — during the last negotiation three years ago,” the news release said.

The request would increase rates by 60% — forcing Florida Blue members overall to pay $150 million more — over the next three years, the insurer said.

Jennifer Smith, Broward Health vice president of communications, said in an interview on Tuesday that Florida Blue has misstated that the hospital system “left the negotiating table.”

“We were talking with them on June 30,” she said. Asked about the 60% increase that Florida Blue said Broward Health is seeking, Smith said, “I don’t think the numbers are exact, but that’s how much they’re underpaying us compared to what they’re paying other health systems and compared to what others are paying us. That’s how far undervalued they have us.”

Florida Blue, she said, “by far is the lowest managed-care payer for us.”

Florida Blue’s statement also contended, “In addition, Broward Health is also demanding a change in how they get paid — from a predictable, fixed-rate (schedule) to a system where they set their own prices. This would let Broward Health 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.”

Broward Health operates five hospitals, one of which is a children’s hospital, and more than 50 physician and ambulatory locations in northern Broward County.

On its website, Broward Health said that Florida Blue has “historically undervalued the care our team members provide.”

It added, “Our discussions with Florida Blue are about fairness; we are simply asking that Florida Blue reimburse our team at levels that are comparable to what they reimburse other health care providers in South Florida, (and) comparable to rates provided by other insurance companies for the same services.”

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.

Emergency room and emergency services are always covered at in-network cost share, even at out-of-network facilities. “This means Florida Blue members can still go to Broward Health for emergency care,” the release said.

Affected members are advised to log into their Florida Blue member accounts to select other in-network hospitals, physicians or clinical sites.

Smith said Broward Health also is helping its patients. “We are going to do everything in our power to care for the patients impacted by this and are actively speaking solutions to keep them at in-network rates, because we actually care about the patients,” she said.

Ron Hurtibise covers business and consumer issues for the South Florida Sun Sentinel. He can be reached by phone at 954-356-4071 or by email at [email protected].

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