Seniors and low-income people may feel the worst effects of the new hospital-insurer deal between Baptist Health and Florida Blue.
Details of the deal reached on Monday began to come into focus on Thursday. Separately, similar negotiations between United Healthcare and University Health System continue to stall.
Taken together, these circumstances demonstrate that challenges remain for tens of thousands of patients in Northeast Florida.
Here’s the problem.
At Baptist Health
Under the new agreement, members of myBlue, a low-cost health maintenance organization, will no longer have access to in-network coverage at Baptist.
To ease the pain, Baptist and Florida Blue announced Thursday that those with myBlue plans will receive a 30-day extension of their in-network coverage that expires on Oct. 31.
HMOs like myBlue limit coverage to care by physicians who work for the organization or contract with the organization to provide care that focuses on prevention and wellness.
In a joint statement Thursday, they pledged to continue care for patients facing serious or ongoing symptoms until March 29.
“On behalf of our Board of Directors, more than 15,000 team members, and 2,000 physicians, we appreciate the community’s patience as we work through the details of this contract transition,” Baptist Health said in a statement Wednesday. Ta.
This transition is likely to be most severe for people 65 and older.
Florida Blue members who use Medicare Advantage to see their primary care physician will no longer be in-network. The region’s largest health insurer, with more than 600,000 members, said it is in the process of transitioning Medicare Advantage customers to new primary care physicians.
Baptist Health professionals will remain in Medicare Advantage’s network for Florida Blue users. The same goes for all emergency, hospital and outpatient services.
Medicare Advantage is a federally funded health insurance plan with monthly premiums. It is for people 65 and older and provides federally funded Medicare plus benefits such as disease management programs, fitness plans, and regular vision, hearing, and dental coverage.
“Florida Blue’s agreement with Baptist Health Jacksonville allows the majority of our members to continue receiving care at Baptist Health Jacksonville at in-network rates without interruption,” the insurer said in a statement. mentioned in.
The two sides reached the agreement late Monday, hours before the hospital-insurer agreement was signed in 2021. Since then, the two organizations have shared information on the content of the new agreement.
Concern spread across the region as Baptist and Florida Blue eyed the possibility that 50,000 people would be forced to pay out-of-network costs to receive care. Teachers unions, city officials and small business owners were among those watching the negotiations closely, fearing rising health care costs.
Dr. Ferdinand Formoso, president of the Duval County Medical Association, praised the agreement.
“The ability of patients, especially those with chronic conditions, to maintain meaningful relationships with their physicians is critical to promoting quality care and positive patient outcomes,” Formoso said in a statement. .
Baptist Health CEO Michael Mayo said the hospital will keep its negotiating website and phone line open for several weeks to help people better understand how the agreement affects their medical decisions. said.
At University Health
Across the St. John’s River, Mayo’s peers hope to settle the hospital-insurance negotiations with one of the largest insurers.
The University of Florida Health System and United Healthcare are in the second month of a contract stalemate that expired at the end of August.
Dr. Marvin Dewar, CEO and chief medical officer of UF Health Physicians, said his organization has never experienced such a long impasse with a major insurance company.
United Healthcare is the second largest commercial insurance company within the UF Health system, with an estimated 75,000 members.
Approximately 26,000 United Healthcare subscribers seek services within the Jacksonville University Health Network, Dewar said.
“United were way behind in terms of what they paid us,” Dewar said. “Effectively, we’re still getting the same income from United today as we were 10 years ago. … The price of milk has gone up. Your rent has gone up. Your bread has gone up in price. Ours. The same goes for all services and wages. …That left a hole. We have to get out of it.”
United Airlines countered on its website that UF Health was spreading misinformation. The public health insurance conglomerate said on its landing page that it has increased reimbursements to UF Health in nine of the past 10 years.
“UF Health’s final offer to us represented a 30% increase over two years and a more than 23% increase in the first year of the contract,” United Airlines wrote. “Why have the right to increase the cost of health care services by seven times the 12-month (Consumer Price Index) trend when consumers and employers are primarily responsible for these increases,” UF Health said. Do you believe that?”
An analysis this year from the Pricewaterhouse Cooper Health Institute found that health care costs will increase by 8% in 2025, the largest increase in 13 years.
Dewar said the financial losses recorded by insurers during the worst of the COVID-19 pandemic, when elective surgeries were often not scheduled and people were putting off some preventative health outcomes, said the windfall was not experienced by the UF Health system.
“We must pay our employees the wages they need and deserve. We want them to serve us in multiple locations, and we want them to have more services in more easily accessible locations. We have patients who want to be able to provide that,” Dewar said. “We want to be able to invest in that, and we need United to step up and do its part so we can invest in health care in our communities.”
Dewar said UF Health System’s biggest needs in negotiations are to receive additional reimbursement early in its contract with United Healthcare and to reduce its rate of medical claim denials from United.
Hours after Florida Blue and Baptist Health reached the agreement, Dewar spoke to Jacksonville Today. Their ability to solve gaps convinced him that the same thing could happen between UF Health and United Healthcare.
“We see first-hand the difficulties it causes when you can’t connect to the network,” he says. “You don’t want other people to go through that hardship.”
“We’re going to continue to work hard to be United’s network provider. We don’t like going out of network, making it more difficult for the 75,000 people who work with United to see us. We are not happy about what has happened. We will continue to work hard and believe that we will succeed 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 in local newsrooms.
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