JACKSONVILLE, Fla. – Florida Blue Medicare Advantage patients should expect some big changes to their insurance coverage if they utilize Baptist Health.
Patients started to report issues as they tried to reschedule appointments on Tuesday and Baptist shared a long statement about the new plan on Wednesday evening, confirming that Medicare Advantage patients are now out of network for primary care physicians only. They are still considered in-network for specialists at Baptist facilities.
“We are thankful for the resolution of our new, long-term contract with Florida Blue, which will be beneficial for our community. We know some people have questions about the details of the transition to the new contract and how it will affect them,” a spokesperson wrote in a statement to News4JAX.
“Most Blue Cross and Blue Shield plans including Federal, State, PPO, Indemnity, Simply Blue, Blue Choice, Blue Care HMO, and Blue Options PPO, will continue to be included in our new contract as well as Florida Blue Medicare, HMO and PPO plans. Both parties agreed to some changes in covered services for Medicare Advantage and myBlue plan members. We want to emphasize that access will continue as follows for these members:
- Medicare Advantage. While all emergency, hospital, outpatient and specialty physician services remain in-network for Medicare Advantage members, Baptist Primary Care will no longer be considered in-network effective October 1. Florida Blue is in the process of reassigning these members to a new PCP and will notify them as soon as possible.
- myBlue. All hospital care for myBlue members aged 17 and under will remain intact with in-network coverage. In addition, for adults 18+, all hospital care that results from an emergency admission, labor and delivery and psychiatric services related to a Baker Act admission will continue to have in-network coverage, as will any transfers from a participating hospital for patients who require a higher level of care not otherwise available.
- Continuity of care coverage is always an option for patients who qualify for this special coverage. For myBlue plan members, this would allow for continued in-network access to all care for a period of six months. The insurance company determines eligibility and approval.”
Florida Blue also issued a statement.
“Baptist requested to no longer participate in myBlue, an affordable low-cost HMO product. We are already working to help our myBlue members transition to other quality in-network myBlue providers across Northeast Florida. Alternatively, myBlue members can choose to switch to a different Florida Blue plan that includes Baptist Health as an in-network provider, but that plan will cost more,” the statement, which can be read in full, reads in part.
“People are very excited. They think as basic communications are put out that they believe their primary care is back in network. It’s just it’s not, though, so that’s not being communicated very well,” Bill Green, a local Medicare insurance agent with Green Insurance, said hours before the statement from Baptist came out.
Green said the new agreement covers specialists and hospital services but excludes primary care for HMO members with a Medicare Advantage plan. He’s was getting calls all Wednesday morning from his clients who were understandably confused.
“While it’s wonderful, they came back to an agreement, if someone wants to maintain seeing their Baptist primary care, if they have a PPO, they can pay the out-of-network, co-pay. Unfortunately, the HMO they just wouldn’t be able to,” Green said.
Viewers have emailed News4JAX reporting issues with their Florida Blue Coverage after Oct 1.
“As of October 1st, Baptist is no longer accepting the ‘my blue’ plan offered through Florida Blue,” one viewer wrote. “[A] Baptist Representative also told me, there’s another Florida Blue they are no longer accepting- ‘Florida Blue Select.’”
“My Baptist doctor just called and said I was not in his plan as Baptist is not taking Florida Blue HMO,” another viewer said in an email.
Patients should confirm with any primary care doctors or specialists that their insurance is still accepted to avoid any out-of-pocket costs.
“The advice would be, if you want to maintain your relationship with your Baptist primary care provider, there are some other Medicare plans that do have them in network. That’s just something we’d have to meet with one on one and go over what somebody’s medical needs and prescription needs are,” Green said.
Green recommends Florida Blue Medicare members call the insurance company to get their primary care reassigned. Visits to hospitals and specialists are not affected.
Full statement from Florida Blue:
“Florida Blue’s new 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. However, Medicare Advantage members will experience changes to their in-network coverage for primary care services, and myBlue members will no longer have Baptist Health Jacksonville as an in-network provider.
Baptist requested to no longer participate in myBlue, an affordable low-cost HMO product. We are already working to help our myBlue members transition to other quality in-network myBlue providers across Northeast Florida. Alternatively, myBlue members can choose to switch to a different Florida Blue plan that includes Baptist Health as an in-network provider, but that plan will cost more.
Baptist Health primary care providers no longer participate in our Medicare Advantage PPO and HMO networks. Members for these plans have already been matched to different primary care providers. Baptist Health specialists and Baptist Health facilities continue to participate in our Medicare Advantage PPO and HMO plans — and our Medicare Advantage PPO and HMO members can continue to receive services from these specialists and facilities at in-network rates.
For more information, our members can visit our landing page, FloridaBlue.com/Negotiation/BaptistHealthJax, or contact Florida Blue at the number located on the back of their member ID card for support.”