Memorial Healthcare System is telling its patients with Blue Cross Blue Shield insurance to find another insurer if they want to remain in southern Broward County’s largest hospital network.
Negotiations on a new contract that would have enabled patients insured by Blue Cross Blue Shield of Florida, also known as Florida Blue, to continue using Memorial hospital facilities at in-network rates failed before the previous contract expired Aug. 31.
As of Sept. 1, patients with Florida Blue or any other Blue Cross Blue Shield plan are no longer eligible for in-network rates for services at Memorial’s six hospitals.
On Monday, Memorial Healthcare’s vice president for managed care, Jeffrey Bross, advised Florida Blue policyholders to begin looking for another insurance company as open enrollment approaches for Medicare Advantage, employer-based and individual health insurance plans.
Although both sides said they would continue to negotiate after the Aug. 31 deadline, that hasn’t happened, Bross said.
“My last communication with Florida Blue was on Sept. 2,” he said. “We sent them a communication that stated our position and highlighted how we have compromised -- we said we accepted a large portion of Florida Blue’s proposals and asked for reciprocation.
“They stated that they had sent us Florida Blue’s last and best offer.”
In an email statement, Florida Blue spokesman Paul Kluding said: “Over the past several weeks we have had several conversations, verbal and written, with Memorial Healthcare System around their terminated status. Memorial does have our best proposal on the table, which represents a fair and equitable increase over their [previous] contract.”
The loss of in-network status affects thousands of Florida Blue policyholders in southern Broward County with Medicare Advantage, employer-based and individual (Obamacare) plans.
Memorial’s most recent email about the issue went out to 17,000 consumers who “currently or recently received physician services at Memorial,” spokeswoman Kerting Baldwin said Monday.
The email included a link to a long list of health insurers that still provide in-network coverage for Memorial hospitals. The link is at mhs.net/patients-visitors/billing/insurance.
The change does not affect all Memorial services. Florida Blue members continue to have in-network access to Memorial emergency rooms, primary care and specialty physicians, urgent care centers and same-day surgical centers. Patients with COVID-19 will continue to be covered if they need services at Memorial hospitals, spokespersons for both entities said.
What’s no longer covered is the use of Memorial’s hospital facilities by those in-network physicians. Florida Blue policyholders now have to find another area hospital -- and a physician contracted to use it -- if they want to be covered for medical procedures.
The inconvenience will be especially acute for consumers with one of Florida Blue’s lower-cost plans that might not include other nearby hospitals in their network, said Cliff Eserman, a Blue Cross Blue Shield sales agent in Wilton Manors.
For example, Miramar patients with Florida Blue’s pricey “Blue Options” individual plan can still go to Cleveland Clinic Florida in Weston, but patients with the lower-cost “Blue Select” plan don’t have that option, Eserman said. They’ll be forced to drive 15 miles south to the nearest Jackson Health System hospital or 20 miles north to the nearest Broward Health hospital, he said.
If the impasse continues, Eserman said he expects a significant migration of policyholders away from Florida Blue and into competitors' plans. Medicare Advantage enrollment begins Oct. 15 while open enrollment for individual health plans begins Nov. 1.
“You have two monopolies battling each other,” he said. “Memorial knows it. Florida Blue knows it. They’re acting like the community doesn’t matter.”
Naoko Prose, a Cooper City resident and Florida Blue member, said by email that Memorial required her to pay $2,000 upfront for major cancer surgery last week. Before the contract expired, she was told she would have to come up with only $200, she said. “The impact and consequences these two parties have created for the community is insurmountable and unethical,” she wrote. “If only I could find stronger words to express my current feelings. What a scary and disappointing situation this has become!”
Prose said she was charged the higher copay despite assurances by Florida Blue and Memorial that patients undergoing treatment when the contract expired might qualify to remain in network for six months after Sept. 1 under a “continuity of care” designation. She said she received a letter from Florida Blue on Saturday affirming that she was approved for continuity of care status until the end of November and was recently told by the insurer that the $2,000 charge was a mistake that would be corrected, she said.
After the old contract expired, officials of each company blamed the other for the impasse.
Florida Blue said Memorial officials asked for rate increases that would force patients to spend thousands of dollars more in out-of-pocket costs for procedures like childbirth, MRIs and appendectomies.
Memorial accused Florida Blue of being unwilling to pay reasonable market rates for its services.
Both companies said remaining disagreements deal primarily with employer-funded group plans. Kluding said accepting Memorial’s terms would increase costs for “already struggling” local business owners.
Memorial’s Bross said Monday that his company is willing to accept Florida Blue’s terms for individual and Affordable Health Care exchange plans, but not without an agreement on employer-funded group plans. “I remain open to meaningful negotiations,” he said. “We just haven’t had any at this point.”
Kluding said Florida Blue remains “eager to build upon our more than 20-year partnership with Memorial.” However, he said the insurer is working closely with other hospital systems in the area “to ensure that our members have access to the care they need.”
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