Time running out for Florida Blue, BayCare to resolve dispute

BayCare Health System has stopped scheduling elective surgeries and procedures for patients with Florida Blue health insurance as the two nonprofits appear to be unable to agree on a new contract.

The two firms have been at loggerheads for the past seven months trying to negotiate new reimbursement rates for medical treatment that covers about 85,000 Florida Blue patients treated by BayCare doctors and hospitals. Talks between executives of both sides are ongoing, with multiple meetings taking place each day, but both sides are far from agreeing, according to Florida Blue, the state’s BlueCross BlueShield provider.

Both sides have accused the other of prioritizing their bottom line over patient needs. If a deal cannot be reached before the current contract expires Oct. 1, tens of thousands of Tampa Bay residents could have to find new doctors.

BayCare operates 15 hospitals across Hillsborough, Pinellas, Pasco and Polk counties and BayCare Medical Group, one of the region’s largest physician groups. After Oct. 1, emergency room visits would still be covered, officials said, but elective surgeries and procedures, and visits to the doctor for checkups and to treat mild illnesses would not.

Related: Florida Blue, BayCare spar over health care coverage

Florida Blue officials say the hospital chain is seeking double-digit rate increases for hospital services and almost triple that for diagnostic ones like X-rays and MRIs and other medical imaging. The hikes would cost Florida Blue upward of $80 million per year, based on the level of current claims.

In a statement released Wednesday, BayCare officials said that the costs of medical workers and supplies increased “substantially” during the pandemic. It accused the insurance company of raising premiums without passing along those increases to medical providers.

“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,” the statement reads. “Last year, it cost us 20% more to care for each patient than before the pandemic, and costs have increased more in 2022. We are simply asking Florida Blue to agree to a fair contract that puts patients’ access first.”

Workers with Florida Blue have already begun calling customers treated by BayCare to try and match them with new doctors and to address customer concerns, the company said. The priority has been to help those most likely to be affected, such as people currently receiving treatment for chronic conditions and those with Health Maintenance Organization policies — more commonly known as HMO plans — which typically do not cover out-of-network providers.

“The contract terms and rate increases demanded by BayCare may be good for their bottom line, but they come at the expense of affordable insurance premiums for Tampa Bay business owners and residents,” said Florida Blue Market President Dave Pizzo in a statement. “High -quality health care is only beneficial to the community if the families and individuals who live here can afford to access it.”

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Three of BayCare’s hospitals are in the southeast Hillsborough County area represented by State Rep. Mike Beltran, R-Lithia. In a letter sent Aug. 29 to BayCare Chief Executive Officer Tommy Inzina, and Florida Blue’s top executive, Patrick Geraghty, Beltran urged them to put patients first and reach an agreement.

In response to their claims of rising health care costs, he noted that Bureau of Labor statistics show that medical inflation is under 5%. His letter also states that both leaders enjoy seven-figure salaries.

“I would like to express to both parties my severe displeasure at the handling of these negotiations. These tactics are hurtful to your reputations, disserve your patients and my constituents, and impair our ability to continue to treat,” the letter states.

Negotiations are expected to continue right up to and possibly even after the deadline, Florida Blue officials said. Some patients whose care is already underway, such as pregnant people or patients receiving chemotherapy, may be eligible for continuity of care and would not need to change providers immediately.

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