Memorial hospitals removed from Florida Blue network after contract talks fail

Thousands of southern Broward County residents with Blue Cross Blue Shield health insurance are being denied in-network coverage for services at Memorial Healthcare System hospitals as of Tuesday.

The insurer and provider failed to come to terms on a long-term pricing contract prior to the Aug. 31 expiration of the previous contract, resulting in Florida Blue removing Memorial’s six hospitals from its preferred provider network.

That means Memorial patients in need of major surgeries will have to pay high out-of-pocket rates at Memorial hospitals or schedule them at hospitals outside of southern Broward to get discounted in-network rates.

Treatment for COVID-19 at Memorial hospitals is still covered, both companies said. In addition, patients treated for an ongoing condition may qualify for six additional months of covered treatment under what’s called a “continuity of care” approval.

Emergency services at Memorial hospitals are still covered for Florida Blue policyholders, as are visits to Memorial-owned outpatient surgical centers and any physician employed by a Memorial-owned group practice.

What’s no longer covered is use of Memorial’s hospitals by those physicians for major surgeries. Patients who seek to have surgery outside Memorial’s system might have to find another physician to perform it.

The change affects Florida Blue members in employer plans, individual plans or Medicare Advantage plans.

Memorial hospitals affected by the change include two in Pembroke Pines, two in Hollywood, one in Miramar, and Joe DiMaggio Children’s Hospital in Hollywood.

Negotiations on a new contract that would reverse the changes are continuing, Florida Blue spokesman Paul Kluding said Tuesday.

Keith Cohen, a Memorial patient who made sure he underwent a needed surgical procedure before the Aug. 31 deadline, said the impasse will create a hardship for southern Broward residents if not resolved soon.

“I don’t know what people are going to do,” Cohen said. “I can’t even imagine how many thousands of people it’s affecting in the area.”

He noted that Broward Health, the hospital system that serves the northern half of Broward County, as well as Cleveland Clinic and others remain in Florida Blue’s network. “Memorial seems to be the only one that can’t make a deal.”

In an email statement Kluding provided on Tuesday, Florida Blue accused Memorial of “refusing to accept fair and competitive contract terms.”

Negotiations over a new contract began with Memorial seeking 40% higher rates over the current contract, Kluding’s statement said.

“Over the past months Florida Blue has aggressively negotiated with Memorial in an effort to provide our members access to affordable care while working to address Memorial’s financial concerns. Unfortunately Memorial leadership remains out of touch with the financial realities that are plaguing the health care system, and have refused to keep our members’ best interest in mind,” the statement said.

In addition, Memorial’s requested rate hikes would “greatly drive up the cost of insurance” and out-of-pocket costs for Florida Blue members, the insurer said.

Memorial, meanwhile, claims it has been a “low-cost provider” for many years and has not received fair price increases.

In its own statement Tuesday, Memorial said it “continues to negotiate in good faith to get our reimbursement rates to fair market value for the next four years, aiming to reach an agreement in which our patients continue to receive the high quality care they deserve and that should be covered under Florida Blue.”

The change in network status affects not only Florida Blue members, but also members of any Blue Cross Blue Shield insurer based outside Florida.

The two companies alerted their customers to the impending loss of network status in early August in letters in which each blamed the other for the impasse.

Memorial sent letters to 53,000 patients with Florida Blue coverage. Florida Blue contacted 25,000 of its members.

Memorial is urging patients confused by how the impasse might affect them to seek more information at its website keepmemorialcovered.com.

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