Patients feel strain of Florida Blue fallout with Broward hospitals: ‘Just lunacy’

Christina Underwood didn’t have much time to make a decision. Doctors at a Broward County urgent care clinic said her 13-year-old daughter’s appendix was at risk of bursting. She needed to get to an emergency room immediately.

This was mid-January, a little after 7 p.m. on a school night. Under normal circumstances, Underwood would have whisked Harper over to the pediatric emergency room that is part of Broward Health Medical Center, about three miles away from their home in Fort Lauderdale. Maybe to Joe DiMaggio Children’s Hospital in Hollywood.

But an ongoing contract dispute has left both public hospitals — and many affiliated doctors — out-of-network with one of the state’s largest health insurers, Florida Blue, formerly known as Blue Cross & Blue Shield of Florida. Families like Underwood’s, who have a health plan under Florida Blue or one of its affiliates, have found themselves locked out of in-network care.

That led Underwood, 47, to drive north nearly an hour away to West Boca Medical Center, where Harper was evaluated in the ER. Doctors said she needed surgery to remove the appendix, but there wasn’t a surgeon available. Harper was then transferred by ambulance to St. Mary’s Medical Center in West Palm Beach, another hour away. That’s where Underwood’s overnight search for care ended, with Harper getting a patient room at 5 a.m. and a surgery scheduled at 11:30 a.m.

Underwood’s harrowing journey to find in-network hospital care for her daughter is just one of the many struggles South Florida patients have experienced while seeking primary and specialty care since Memorial Healthcare System and Broward Health were booted out of Florida Blue’s network last year.

The public hospitals left Florida Blue’s network after pay rate negotiations with the insurer fell through. Both hospitals have accused Florida Blue of not paying them enough for care. Florida Blue, meanwhile, is accusing the health systems of wanting too much money.

And more patients could soon find themselves in a similar situation. Cleveland Clinic, which has a hospital in Weston and medical centers in other parts of Broward, could leave Florida Blue’s network by early March if its own contract negotiations with the insurer fall through.

Broward patients who filled out a Miami Herald survey said they’ve struggled to find new in-network doctors to continue treatment for cancer and other conditions. Some are now driving farther for care to Miami-Dade and Palm Beach counties. Others have chosen the costlier route and are paying out of pocket to continue care with their trusted providers. A few readers said they’ve even moved out of state for care now that they’re unable to see their Broward specialists.

Members of Florida Blue and its affiliates can still seek emergency care at hospitals run by Broward Health and Memorial. Health insurers are required to cover emergency services at any hospital in the country as if it’s in-network, even if it’s out-of-network. But, “I don’t know what that means in real-life terms,” Underwood said.

Questions and scenarios swirled in her head that January night: If Harper was admitted into an out-of-network ER, would she have to fight with every doctor to get insurance coverage? Would she be forced to transfer hospitals? Would just the ER visit be covered — but the rest not?

She tried calling her insurance, Anthem Blue, for guidance, but nobody answered since it was after hours.

Time was of the essence. Harper was in pain. The longer they waited, the more likely it was that her appendix could rupture, putting her health at even more risk.

“I couldn’t chance that,” Underwood said.

Underwood is one of tens of thousands of patients left navigating the fallout between the Broward hospitals and Florida Blue, which insures about a third of the state’s population and has a strong presence in South Florida. The insurance company said it notified just under 60,000 Florida Blue policyholders who had received care at Memorial or Broward Health in 2025 that they would be affected. But the dispute may be impacting even more patients, including those who did not seek care at the hospitals last year.

READ MORE: Do you have Florida Blue and need care? Here are some Broward options

It’s not uncommon for hospitals and insurers to go back and forth over reimbursement rates, prior authorization and other factors, according to Jason Buxbaum, a Brown University professor who has tracked contract disputes between hospitals and health insurers since 2021.

But what’s happening in Broward County “is a really exceptional and unusual dispute to go on this long,” said Buxbaum, an assistant professor of health services, policy and practice at Brown’s School of Public Health.

From June 2021 to May 2025, about 1 in 5 hospitals had at least one public dispute with an insurer, according to Buxbaum. He believes it’s possible that federal transparency laws are making it easier for patients, hospitals and insurers to compare prices between competitors for surgeries and other procedures. That extra level of transparency can lead to more “aggressive negotiations” that eventually spill out into the public eye as a pressure tactic, according to Buxbaum.

“That is the ugly, like, truth of it,” he said, noting that “patients are going to slip through the cracks” and “be made uncomfortable” in the meantime. And the only thing patients can really do at this moment is advocate for their care by calling or writing the hospitals, the health insurer and their state representatives, the professor said.

“I feel for so many patients. … Hospitals are trying to do right as they see right. Insurers are trying to do right as they see right. There’s almost never a black-and-white case of greedy insurer, greedy hospital,” Buxbaum said. “There are hard trade-offs here, and this is how these public disputes — how some of these trade-offs — are getting hashed out.”

Memorial Healthcare System, in a lengthy statement to the Herald, described its removal as an in-network provider for Florida Blue as “disheartening” and indicated that the insurer knew the “decision would cause hardship for their customers, our patients.”

“Memorial has sought to continue its longstanding partnership with Florida Blue and remains ready and willing to reach a fair agreement that protects patients’ access to the services and physicians they know and trust,” the statement reads.

The public safety net hospital also gave more insight into the ongoing dispute, including by saying that it’s still trying to get Florida Blue to pay more than $150 million in outstanding claims for care provided to its members over the past five years. Florida Blue did not directly respond to a question from the Herald about Memorial’s claim.

“While Memorial has repeatedly offered compromises, reasonable adjustments that would begin to narrow, though not eliminate, the gap between Florida Blue and our other insurance partners, Florida Blue has not issued a fair rate proposal,” the hospital said. “An agreement cannot be reached until the company agrees to reasonably compensate Memorial for the unique, specialized care and complex services we provide, services that many for-profit healthcare systems in this region are unwilling to take on.”

Broward Health, the public hospital system that mainly serves northern Broward, also stressed its commitment to resolve its own contract dispute and said in a statement to the Herald that it had made multiple offers to “bring in an independent, third-party moderator to help negotiate” a deal, but Florida Blue declined. Florida Blue did not directly respond to a question from the Herald about the hospital’s assertion.

Broward Health also said that “these negotiations are about FL Blue treating Broward Health fairly.” Broward Health said its most recent proposal to the health insurer reflected reimbursement rates that are based on “fair market value” and not percent increases.

Fair treatment is also the core argument of Florida Blue.

“It’s a challenge. … I feel bad for the people of Broward County,” David Wagner, the South Florida market president of Florida Blue, told the Herald during a brief interview at the Business of Health Care conference at the University of Miami on Feb. 6.

Wagner, a former respiratory therapist who also lives in Broward County, said he knows how important the Broward hospitals and affiliated doctors’ offices are for patients who have now found themselves out-of-network, noting that his own three children were born at Memorial. He praised the nurses, doctors and other frontline workers there.

But Wagner said the contract dispute between the public hospitals and the insurers is related to “affordability.”

“At the end of the day, for our members, it was unaffordable,” Wagner said, referring to the reimbursement rates the hospitals have requested. Florida Blue, on webpages dedicated to the ongoing negotiation, has described Memorial and Broward Health as wanting “unreasonable and excessive rate increases.”

Broward Health wants a “60% increase in rates over the next three years, which would result in over $150 million in higher health care costs for our members who are already struggling during this time of economic strain,” Florida Blue’s website says. “Broward Health also wants the ability to increase costs — at any time and without explanation or justification — for services, critical medications, and treatments such as chemotherapy and immunotherapy. Through experience with another health system in Broward County, we know this leads to ‘surprise medical bills’ including unpredictable and often exorbitant costs for patients.”

In a written response to the Herald, Broward Health said, in part: “The fact that Florida Blue has historically underpaid Broward Health — a safety net hospital system that cares for our community’s most in need — 60% below fair market value is unfathomable.” It also said that “allegations that we asked for the ‘ability to increase costs — at any time and without explanation ... ‘ are absolutely false.”

Florida Blue is also calling for Memorial to provide “more transparency and predictability in what patients are charged, to avoid large ‘surprise bills’ for individuals, families, and employer groups.”

“During their current contract, Memorial Healthcare System has made a practice of increasing charges in a way that far exceeds standards,” Florida Blue’s website says. “For example, their charges for cancer-fighting chemotherapy have skyrocketed over the past 4 years, resulting in a 150% increase in the average cost of a single course of treatment.”

The insurer is also criticizing Memorial for “demanding significant rate increases” for Florida Blue’s low-cost individual health plan, myBlue, which is available through the government-run marketplace for health insurance that was created through the Affordable Care Act, also known as Obamacare.

Memorial and Broward Health, which currently share the same CEO, Shane Strum, own Community Care Plan, a health insurance company that for nearly 30 years has offered government-sponsored plans to families through Medicaid, Florida Healthy Kids and programs for the uninsured. In November, the hospitals expanded into the ACA Marketplace with their own commercial insurer, 22 Health — pitting them head-to-head with Florida Blue and other insurers.

Memorial disputes Florida Blue’s claims and said contracts “ensure there is no surprise billing and provide clarity and protection for all parties involved” and that its commitment to transparency and accountability also includes “ensuring providers are appropriately reimbursed for the care they have already delivered.”

Still, Wagner said he remains “optimistic” that Memorial, Broward Health and the insurer will come to a deal. He also said “talks are going well” with Cleveland Clinic, which is also in the midst of contract negotiations.

Cleveland Clinic, in turn, told the Herald it’s “working hard to reach a new agreement, and it is our goal to come to a resolution with Florida Blue and avoid any changes that would disrupt our patients’ current healthcare coverage.”

But if Cleveland Clinic and Florida Blue fail to make a deal, the hospital says it will no longer be in-network for patients with the insurance as early as March 1. However, Florida Blue states on its website that under the current agreement with the hospital, members would have in-network access to all Cleveland Clinic facilities and physicians through at least May.

The health insurer said some patients may still be able to continue getting in-network care at Cleveland Clinic for a certain period of time under federal and state protections for continuity of care. That 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.

Kara Skorupa, a 56-year-old health care attorney, has been a patient at Memorial for many years, and her husband has worked for a radiology group at the health system for over two decades.

Her husband’s work changed its insurance to Florida Blue for 2026, leaving Skorupa and many others out-of-network with Memorial and Broward Health. That means the couple can’t get care at the hospital system where he works.

It’s “just lunacy to me that a hospital-based physician group can’t even go to the hospital which they staff,” Skorupa said.

The fallout has forced Skorupa, a breast cancer patient, to seek care closer to her Miami Beach home. She’s now undergoing treatment at Mount Sinai Medical Center’s new cancer center. Mount Sinai’s care is great, she said, but the change hasn’t been easy for her.

“I have been feeling vulnerable … and I didn’t realize how much faith I had in the Memorial system until I was shut out,” she said.

Skorupa said that since she was diagnosed in June, she willingly made the hourlong trek each way to get care with her Memorial oncology team, whom she grew “attached” to throughout her difficult treatment.

The mother of two said she never expected to find herself searching for a new oncologist who was in-network and accepting patients.

“It felt like a divorce,” she said.

“Midnight on December 31, everyone’s cheering, but I wasn’t, because I knew that my care had changed fundamentally,” she added.

Wagner, the Florida Blue executive, is encouraging patients to seek care, for now at least, at other health systems that are part of Florida Blue’s network. That includes Holy Cross Fort Lauderdale and South Florida facilities operated by HCA Florida, which owns MD Now urgent care clinics and has four Broward-based hospitals.

Members can also turn to various Sanitas Medical Centers across Broward. Sanitas, which has a partnership with Florida Blue’s parent company, primarily provides primary and specialty care services to members of Florida Blue and other Blue Cross Blue Shield plans.

Baptist Health South Florida and Nicklaus Children’s Hospital also have centers in Broward, just not a dedicated hospital. Nicklaus doctors at Broward Health remain in-network, according to Broward Health.

But the situation is still aggravating for patients like Oakland Park resident Anna Mae Dominguez. Florida Blue has spared the 70-year-old from many hefty hospital bills through the years, including a recent $51,000 hospitalization at Holy Cross Hospital in Fort Lauderdale.

Everyone used to take Blue Cross Blue Shield, she said.

“I never ran into a person, to a doctor, a hospital or somebody that didn’t take it, and now I’m up against this brick wall,” said Dominguez. “And as you get older, you require more health care, and it becomes even more difficult to manipulate the system if you’re not familiar enough with it.”

Dominguez feels she’s at a crossroad. She’s frequently relied on Broward Health and affiliated doctors for care through the years. Broward Health’s Imperial Point is the nearest hospital to her.

But now, she’s locked out of in-network care, not just with Broward Health and Memorial Health hospitals, but with many affiliated doctors — “like a snowball effect” — and is wondering if it’s worth continuing to pay for Florida Blue, an insurance she’s had for decades.

It was the insurance her husband, a since-retired postal worker, used to get through his job. Once she turned 65, she switched to Medicare Part A & B and began to pay $411 a month for Florida Blue as her secondary insurance.

It’s come in handy. Florida Blue, for example, paid the leftover Holy Cross hospitalization charges that Medicare did not cover.

“My main reason for keeping Blue Cross Blue Shield … I can go anywhere worldwide and use it,” she said. “If I move to another country, or if I visit another country, I don’t have Medicare A & B, but my Blue Cross Blue Shield would step up and pay 100%.”

Still, Dominguez isn’t sure the peace of mind during her international travels is worth losing access to care near home.

“I don’t feel sometimes as though I’m getting the best quality of my choice,” Dominguez said.

Still, she’s luckier than others. Dominguez hasn’t had to find new doctors because of the insurance fallout. The doctors she sees who are affiliated with Broward Health are also affiliated with other health systems that are still in-network, she said. But she finds herself constantly reminding staff to not send her to Broward Health-affiliated facilities for services.

For Underwood, whose daughter recently underwent emergency surgery to remove her appendix, the long drives, sleepless night and hours of pain could have been avoided if her local hospitals were in-network, she said.

“It’s one thing when you can’t go to your doctor, it’s one thing when you’re put in that inconvenience,” Underwood said. “But firsthand, for me to have the crisis with my child, where it’s a medical emergency, it makes it very real, very fast.”

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