The people who may feel the worst reverberation of the new hospital-insurer agreement between Baptist Health and Florida Blue may be older adults and low-income people.
Details of the agreement, reached Monday, began to come into focus Thursday. And separately, an impasse remains in similar negotiations between United Healthcare and the UF Health system.
Together, the situations indicate challenges remain for tens of thousands of patients in Northeast Florida.
Here’s where the issues stand.
At Baptist Health
Under the new agreement, members of myBlue, a low-cost Health Maintenance Organization, will no longer have in-network coverage at Baptist.
To alleviate that sting, Baptist and Florida Blue announced Thursday that those with a myBlue plan will have a 30-day extension to the in-network coverage that expires Oct. 31.
HMOs like myBlue limit coverage to care from doctors who work for or contract with the organization and provide care that focuses on prevention and wellness.
Thursday’s joint statement pledged continuity of care for patients who are facing serious or ongoing conditions until March 29.
“On behalf of our board, our more than 15,000 team members and 2,000 physicians, we appreciate our community’s patience as we work through the details of this contract transition,” Baptist Health wrote in a statement Wednesday.
The transition may be most acute for people older than 65.
Florida Blue members who use Medicare Advantage to see their primary care physician will no longer be in network. The region’s largest health insurance provider, with more than 600,000 members, says it is in the process of transitioning Medicare Advantage users to new primary care physicians.
Specialists at Baptist Health will remain in network for Florida Blue users with Medicare Advantage. So too will all emergency, hospital and outpatient services.
Medicare Advantage is a health insurance plan funded by the federal government and monthly premiums. It’s designed for ages 65 and older and provides benefits like disease management programs, fitness plans, and routine vision, hearing and dental coverage, in addition to the federally funded Medicare.
“Florida Blue’s agreement with Baptist Health Jacksonville enables the great majority of our members to continue receiving care at Baptist Health Jacksonville at in-network rates without disruption,” the insurer said in a statement.
The two sides reached an agreement late Monday, hours ahead of the conclusion of the hospital-insurer agreement that was signed in 2021. Since that time, the organizations have shared information on what the new agreement entails.
As Baptist and Florida Blue stared down the possibility of 50,000 people being forced to pay out-of-network costs to access care, there was concern throughout the region. Teachers’ unions, municipal employees and small-business owners were among those who closely followed the negotiations, fearful their medical costs would skyrocket.
Duval County Medical Society president Dr. Ferdinand Formoso applauded the agreement.
“The ability of patients, especially those with chronic conditions, to maintain the meaningful relationships they have with their treating physicians is extremely important for promoting quality care and positive patient outcomes,” Formoso said in a statement.
Baptist Health CEO Michael Mayo says the hospital will keep the negotiation website and its phone lines open for a few weeks to help people further understand the effect the agreement may have on their health care decisions.
At UF Health
Mayo’s peers on the other side of the St. Johns River hope to resolve their hospital-insurer negotiations with one of its biggest providers.
The University of Florida health system and United Healthcare are in the second month of a standoff in their contract, which expired at the end of August.
Dr. Marvin Dewar, CEO and chief medical officer for UF Health Physicians, says his organization has never experienced an impasse of this length with a major insurer.
United Healthcare is the second-largest commercial insurance provider within the UF Health system with an estimated 75,000 members.
Dewar says about 26,000 people who have United Healthcare seek services within the UF Health Jacksonville network.
“United had gotten way behind in terms of what they were paying us,” Dewar says. “Effectively, when we look at it, we were earning the same thing from United now as we did 10 years ago. … The price of your milk has gone up. The price of your rent has gone up. Your bread has gone up. The same thing for us for all of our services and wages. … That has created a hole. We’ve got to get out of that.”
United retorted on its website that UF Health pushes disinformation. In a landing page, the public health insurance conglomerate says it has increased its reimbursement to UF Health in nine of the last 10 years.
“UF Health’s last proposal to us represented a 30% price hike in two years and a more than 23% rate increase in the first year of our contract,” United wrote. “Why does UF Health believe it is entitled to increase its costs by seven times the 12-month [Consumer Price Index] trends for medical services, when consumers and employers would be largely responsible for these increases?”
An analysis this year from Pricewatershouse Cooper’s Health Research Institute found that medical costs will increase 8% in 2025 — the highest increase in 13 years.
Dewar says the financial windfall that insurance companies recorded during the worst of the COVID-19 pandemic —when elective surgeries were often not scheduled and people postponed some preventative health outcomes — was not experienced by the UF Health system.
“We have to pay our staff the wages they need and deserve. We have patients who want us to deliver services at multiple locations and want more services in more places that are easily accessible,” Dewar says. “We want to be able to invest in that, and we’ve got to have United step up and play its part so we can invest in the health care of our communities.”
Dewar says the biggest needs for the UF Health system in its negotiations are receiving additional reimbursement early in its contract with United Healthcare as well as reducing the percentage of medical claims denials from United.
Dewar spoke with Jacksonville Today hours after Florida Blue and Baptist Health reached their agreement. Their ability to resolve their gaps gave him belief that the same can take place between UF Health and United Healthcare.
“We see the struggle that it causes when you’re out of network,” he says. “You don’t like for anyone else to have to go through that struggle.”
“We are going to keep trying as hard as we can to become a network provider for United. We don’t relish being out of network. We don’t relish the 75,000 people who have United have more difficulty in seeing us. We’re going to keep trying. I going to assume that we’re going to be successful someday.”
Disclosure: United Healthcare is the health insurance provider for WJCT Public Media, the parent organization of Jacksonville Today. Florida Blue and Baptist Health are both financial supporters of WJCT Public Media..
Will Brown is a corps member with Report for America, a national service program that places journalists into local newsrooms.
Copyright 2024 Health News Florida
