RIVERVIEW, Fla. — With just months left in his daughter’s chemotherapy treatments, John Feely said he got a recent shock that felt all too familiar.
It was a letter from BayCare Health System letting patients and their families know that they’re currently in the midst of heated contract negotiations with insurance provider Florida Blue.
The letter goes on to say that if the two can’t reach an agreement by the end of September, come October 1, Florida Blue will no longer be accepted in the BayCare network.
The Feelys said they’ve experienced this before, with a different insurance provider during 7-year-old Selah’s first cancer diagnosis a few years ago.
“My wife and I looked at each other and we were just like ‘really, is this really going to happen again,'” said John Feely, “To be honest, we were still trying to sort through the issues that remained from 2019 to 2020.”
As a result, a change.org petition quickly sprung up on Selah’s behalf, which calls for the two to come to an agreement so her treatments can continue to be covered.
Feely said the attention led to calls from both with an offer to either keep their insurance and change hospitals or ditch their insurance for another provider that BayCare has a contract with.
“To be honest, she’s gotten amazing care from her doctors for the last few years, who know her case, and her case is a complicated one, and so we really don’t want to do either of those two,” said John Feely .
Feely said there’s also a third option — BayCare and Florida Blue are working to offer a “continuity of care” plan for patients still in the middle of certain treatments. This would run anywhere from three to six months, depending on the patient’s plan, and lock in coverage and current prices for care.
In Selah’s case, Feely said she qualifies for the three-month option. Her family hopes to use that care plan to finish up her chemotherapy treatments in hopes that by the time they’re done, Florida Blue and BayCare would have come agreement that works for thousands of patients like Selah.
“I do feel like the people on both sides truly want to help,” said Feely.
ABC Action News reached out to both Florida Blue and BayCare for a better understanding of how they got here.
Here’s what BayCare had to say:
BayCare still has a contract to serve Florida blue customers, and we have been working hard over the last several months to reach a new, fair agreement with Florida Blue before Sept. 30, the date the current contract sunsets. We very much want to reach an agreement that protects patients’ ability to continue choosing the hospitals, laboratory services and physicians they know and trust at BayCare.
BayCare is asking Florida blue to put patients first and negotiate a responsible agreement so that we can attract and retain caregivers and invest in new medical technology to improve patient outcomes and experience. BayCare is a not-for-profit organization. We are committed to reinvesting in patient care and the caregivers who provide it.
Every year, Florida Blue asks its members and employers to pay more for their health insurance coverage, but those increases are not proportionately shared with health care providers like BayCare.
Instead, insurers like Florida Blue are shifting the cost of care to patients by demanding higher premiums and deductibles. Patients often find that, even though they pay high monthly premiums for health insurance, their insurance company still requires them to shoulder a large portion of their cost of care.
It is also important to know there are provisions required by law in these situations that protect patients in active treatment. “continuity of care” benefits allow patients to continue to see their trusted providers through active treatment. To apply for continuity of care benefits, patients need to contact Florida Blue directly.
For more information, including answers to frequently asked questions, please visit keepbaycare.org
Here’s what Florida Blue released:
BayCare health system notified us that they would like to terminate their current contract with Florida Blue and start negotiations on a new contract. We have been working with them since February 2022 in hopes of reaching a new agreement.
Unfortunately, BayCare is demanding extremely large increases in the amount they are paid to care for our members. The increases demanded by BayCare health system total more than $80 million in additional costs that our Tampa bay members would have to pay each year – in addition to their current premiums and out-of-pocket costs.
We cannot possibly put this excessive burden on the people and businesses in Pinellas, Pasco, Hillsborough, and Polk counties. Quality health care is only beneficial to the community if the families and individuals who live there can afford to access it.
Florida Blue is offering BayCare competitive contract terms with a meaningful increase in what we will pay for services under our current agreement. We are disappointed and surprised that they expect an exorbitant rate hike that would impact the entire community.
Additionally, BayCare is demanding contract terms that would provide no accountability on their part to work collaboratively with us to ensure the services and procedures they are recommending and performing are covered by their patients’ health plan benefits.
Because of this, we have not yet reached an agreement. And if we are unable to, BayCare health system will withdraw all its facilities, doctors and other services from our Florida Blue network beginning October 1, 2022.
We are continuing to negotiate with BayCare in hopes that they will reconsider their position and remain in the Florida Blue networks.
Here is an update on continuity of care:
We are trying to work with BayCare health system to develop continuity-of-care processes to help minimize potential disruption for our members in the middle of active treatment, for conditions such as pregnancy, surgery and follow-up care, physical therapy, radiation oncology , and chemotherapy. Continuity of care allows our eligible members receiving active treatment from BayCare health system to continue their treatment at the same out-of-pocket costs – even if BayCare exits Florida Blue’s networks. The length of time continuity of care is available varies by the type of health plan a member has in accordance with the state and federal guidelines.
Florida Blue members should not need to do anything to request continuity of care benefits. We will analyze medical claims to identify who has used BayCare health system over the past 90 days. This will help us determine which Florida Blue members may be in active treatment for a serious or complex medical condition and are eligible for continuity of care, and we will reach out to those members directly before October 1.
For more in-depth information, here is the list of criteria for members to qualify for continuity of care:
- Undergoing a course of treatment for a serious and complex condition from a BayCare provider or facility;
- Undergoing a course of institutional or inpatient care from a BayCare provider or facility;
- Scheduled to undergo nonelective surgery from a BayCare provider, including receipt of postoperative care from a BayCare provider or facility with respect to such a surgery;
- Pregnant and undergoing a course of treatment for the pregnancy from a BayCare provider or facility; or
- Is or was determined to be terminally ill (as determined under section 1861(dd)(3)(a) of the social security act) and is receiving treatment for such illness from a BayCare provider or facility.
We are encouraging our members to also visit https://www.floridablue.com/negotiatingforyou.
– Florida Blue