Florida Blue is in contract negotiations with BayCare Health System, Inc. (BayCare), which operates hospitals, physician groups, and ancillary facilities throughout Tampa Bay and in Polk County.
BayCare has been a longstanding provider partner of ours, and Florida Blue is currently negotiating in good faith. BayCare is seeking contract terms with significantly higher rates, which could lead to substantial increases in health care costs for our members. Agreeing to their demands would raise how much members pay for services at BayCare and could drive up their health insurance each month. During these challenging economic times, all of us in health care have a responsibility to ensure health care remains as affordable as possible and the large rate increases BayCare wants are not reasonable or sustainable.
We remain hopeful and focused on avoiding any health care disruption for our members, and on reaching an agreement to keep this provider in network without significantly increasing health care costs for our members or the community.
We are asking the leadership at BayCare to prioritize the needs of individuals, families, area employers, and the community by negotiating on sensible and sustainable terms before this contract expires.
If we do not reach an agreement, and BayCare chooses to leave our network, they will be an out-of-network provider as of October 1, 2025.
Impacted counties:
- Hillsborough,
- Pasco,
- Pinellas, and
- Polk
Impacted lines of business:
- BlueCare (Health Options)
- BlueChoice
- HMO Group
- BlueSelect
- myBlue HMO
- Medicare Advantage HMO
- SimplyBlue
- Medicare Advantage PPO
- Traditional Indemnity
- Advantage65
- BlueOptions
Provider impacts if this system would become non-participating:
Hospitals, physician groups, ambulatory surgical centers, urgent care centers, radiology imaging centers, and skilled nursing facilities that would be out of network include:
Primary Care Physician (PCP) reassignment may be necessary, depending on how negotiations progress.
HMO Member Impacts (assigned to a BayCare PCP) are listed below:
Member notification impact by segment: All members treated by a BayCare provider during the claims six-month utilization look back will receive a pretermination notification.*
*Reminder: If a member’s group is on the Sales Do Not Mail List, the member will not receive a pretermination notification.
Group and Member outreach
As required, we notify members who have received treatment at BayCare within the last six months, as well as employer groups throughout the impacted counties listed above.-
- Member notification is underway. As required by Medicare compliance, letters are going out this week to Florida Blue Medicare members.
- For notifying Florida Blue Commercial members, we have a little more time to meet compliance notification requirements. These notification letters will go out, if needed, based on the progress of negotiation discussions and compliance requirements for this segment.
MAHMO
While our goal is a mutually beneficial agreement with BayCare, it’s important to acknowledge that the outcome may not be the same for all members and all health plans. If there is any product that is not part of the final agreement, we will support a member who may no longer have access to BayCare in their provider network, ensuring a smooth transition to another provider.
Alternative Providers:
Throughout the Tampa Bay region and in Polk County, we have a large network of providers who share our commitment to high-quality, cost-effective care — meaning our members have plenty of convenient, in-network options should BayCare choose to leave your network. Members and employers can find other in-network providers by visiting our website at FloridaBlue.com or by calling the customer service number located on the back of their member ID card. Alternative in-network acute carehospitals are provided below.
Continuity of Care (COC) for members in active treatment
Florida Blue will work with BayCare to minimize potential disruption for members in active treatment by implementing continuity of care processes that conform to state and federal guidelines. We’ve developed a Continuity of Care (COC) flyer for you to share with members or employers to help answer questions about continuing to get care from BayCare.Commercial HMO members:
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- COC processes are applicable to Florida Blue commercial HMO members in accordance with Florida law. The COC timeframe for Florida Blue Commercial HMO members is up to six months. The COC timeframe for pregnant members being treated by a BayCare provider is through the postpartum visit.
- COC may apply to members who are currently in active treatment at a BayCare. (For example: physical therapy, chemotherapy, radiation, and transplant services.)
- COC may apply to members who are currently in active treatment and included hospital services at a BayCare facility.
Commercial PPO members
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- COC processes are applicable to Florida Blue commercial PPO members in accordance with the No Surprises Act. The COC timeframe for Florida Blue Commercial PPO members is up to 90 days.
- COC may apply to members who are currently in active treatment with a BayCare provider. (For example: physical therapy, chemotherapy, radiation, and transplant services.)
- COC may apply to members who are currently in active treatment with a physician and such active treatment has routinely included hospital services at a BayCare facility.
Member PCP reassignment
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- Some members may need to be reassigned to new PCPs to meet compliance requirements. Commercial HMO and Medicare Advantage HMO members may be reassigned to a new PCP effective October 1, 2025.
- These impacted members may be notified of the PCP change during the week of September 29, or sooner. This will allow them time to select an alternate new PCP if they wish to do so.
Next Steps
Review the information in this article so that you are prepared to answer questions from members and groups. We’ve developed talking points to help you respond to questions from groups and key stakeholders.Talking Points – So What’s happening?
- We developed talking points to help you respond to questions from groups and members.
- BayCare notified us that they would like to negotiate a new contract with Florida Blue, and we have been collaborating with them on a new agreement.
- Unfortunately, BayCare is asking for a significant increase in the amount they are paid to care for our members.
- Such large increases would greatly drive up how much customers pay for services at BayCare as well as how much they pay for health insurance each month.
- 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 they expect an exorbitant rate hike that would impact the entire community.
- BayCare is building a new hospital in Palmetto, set to open in 2027. While we support expanding care options for growing communities, we’re deeply concerned that the rates BayCare is demanding for this new location are not affordable or reasonable for the Manatee County community. BayCare should not condition or jeopardize the current negotiations for their many existing hospitals based on rate demands
- for a new location that hasn’t opened. Their excessive demands would have far-reaching consequences in Manatee County, making health care even less affordable across this area.
- Florida Blue is not owned by stockholders focused on profits. We are part of a not-for-profit organization which allows us to put our members first and focus on our mission — dedicated to helping people and communities achieve better health.
- Florida Blue is committed to partnering with hospitals, doctors, and other health care providers to deliver quality care and improve the cost of health care for every community and member we serve.
- We have several collaborative partnerships with other health systems and health care providers in the area, which support our efforts to improve the affordability and quality of health care offered to our members without unrealistic pricing.
- We are asking BayCare to put our members, local employers, and the community first by continuing to negotiate collaboratively before our contract expires.
Finding another doctor
- Please don’t worry! We have a large network of high-quality doctors and other health care providers in the network who are near you. I would be happy to assist you now, or if you would like to look through the list of doctors on your own, visit our online provider directory at FloridaBlue.com.
- For face-to-face support, and if in Florida, visit your local Florida Blue agent or one of our Florida Blue Centers. We can provide you with the location of your nearest Florida Blue Center or you can find a local Florida Blue Center online at FloridaBlue.com/Center.
- Our Florida Blue Center teams are ready to help in person, by phone, or through a virtual visit — whatever works best for you. Just call 1-877-352-5830, Monday through Friday, 9 a.m. to 7 p.m. or Saturday, 9 a.m. to 4 p.m. You can also visit FloridaBlue.com/Center to find a nearby center or schedule a virtual visit.
What this means for the member
- You do not need to wait until October 1, 2025, to begin your transition to a new doctor. We encourage you to move forward with selecting a new doctor now or during Open Enrollment, if applicable, so you can schedule your first visit and start to build a relationship with your new doctor.
- I can help you find high-quality doctors in your area who continue to accept your health plan. Also, you can find a list of local primary care doctors by:
- – Searching online at FloridaBlue.com using the Find a Doctor tool.
- – Visiting FloridaBlue.com/Center to locate a nearby Florida Blue Center for face-to-face assistance.
- – Calling us at the number on the back of your member ID card.
- If you’d like to transition to a new doctor before October 1, 2025, please let us know. Or go to the Florida Blue app.
- – Open My Account on the Florida Blue app, scroll down to My Providers and follow the onscreen prompts.
- – Visit FloridaBlue.com/Center to locate a nearby Florida Blue
- – Call us at the number on the back of the ID card
A few Questions Answered:
If a member wants to choose a different primary care doctor, when would that change become effective?
If the change is made the first week of the month, it is effective immediately. If after the first week, it is effective first of the following month. Exceptions can be made if it’s an access to care issue.
What other physicians are within Florida Blue’s health plan network?
To find other physicians in your area, please check the Florida Blue online provider directory or call the number located on the back of your Florida Blue member ID card.
Will BayCare providers accept self-pay Florida Blue members as patients if BayCare chooses to leave the network?
If an appointment is related to active treatment and COC applies, then BayCare providers should continue to see the member. If, however, it is just a routine visit and not subject to COC, then BayCare is under no contractual or legal obligation to see any member.
Pasco, Pinellas, and Polk counties and the care teams are ready to help commercial members looking for primary care services. Five of these locations are available to also serve Medicare members.
What happens in an emergency if I or a family member goes to or is sent to a BayCare facility because it’s the closest location?
Under federal and state law, emergency services are unique from other types of care. In the event of a true emergency, ER and emergency services are covered, even at out-of-network facilities, so you could still go to BayCare for emergency care.
All Commercial members
- Florida Blue plans cover emergency services for Commercial members at an out-of-network emergency room at the in-network cost share.
- If you’re admitted to a BayCare hospital after a visit to their ER, even if the hospital is no longer in the network, the hospital stay for that emergency is covered at your in-network cost share.
- A subsequent visit to the hospital, outside of the emergency, would not be covered at the in-network cost share.
Medicare HMO members
- Florida Blue plans cover emergency services for Medicare HMO members at an out-of-network emergency room at the in-network cost share.
- If an HMO member is admitted after a visit to a BayCare ER, even if the hospital is no longer in the network, the hospital stay for that emergency is covered at their in-network cost share until the member’s health is stable.
- Florida Blue will then work closely with the member and their health care team to coordinate a transfer to an in-network hospital, so the member can continue receiving the care they need without any gaps or disruptions.
Medicare PPO members
- Florida Blue plans cover emergency services for Medicare PPO members at an out-of-network emergency room at the out-of-network cost share.
- If a PPO member is admitted after a visit to a BayCare ER and they are no longer in the network, the cost for the hospital stay for that emergency will be at the out-of-network rate.
- Once the member’s health is stable, we’d would work closely with the member to and their health care team to coordinate a transfer to an in-network hospital if they preferred to be cared for at an in-network hospital.
Where can I learn more about Florida Blue’s contract negotiations with providers?
To help educate individual and group members about the contract negotiations process, we have developed informational tools that highlight how we continually work with doctors, pharmacies, and other health care facilities and providers, advocating in the best interest of the communities we serve. To learn more, please visit FloridaBlue.com/Negotiation/BayCare. We encourage you to share the link with yourcustomers and business partners to help them understand how we’re working on their behalf to help keep health care affordable and ensure they can continue to get the quality care they need.
Talk with me, Rikki Topps, to learn how life insurance can help protect everything you’ve worked so hard to build.
More FAQ’s
Is Florida Blue Medicare seeking an agreement with BayCare?
Yes. We value our relationship with BayCare and hope to reach an agreement before October 1, 2025, that is beneficial to our Florida Blue Medicare members and the communities we both serve.
Why has a fair agreement not been reached?
- The high rate increases demanded by BayCare would drive up the cost of health care and insurance for our customers and the communities we both serve. In contrast, we are confident the contract terms we proposed are fair and competitive and are hopeful BayCare decides to remain in our network.
- Florida Blue Medicare’s history is rooted in serving the needs of Floridians in all 67 counties in the state. To ensure affordable, accessible, quality health care for members like you, we are obligated to negotiate with providers to manage the rising cost of health care and keep the system equitable and sustainable.
- Unlike publicly traded insurance companies, Florida Blue Medicare is part of a non-profit mutual holding company that puts the interests of our members first and is dedicated to helping people and communities achieve better health.
If an agreement is not reached, which acute care hospitals will be out of network effective October 1, 2025?
BayCare and all its facilities will be out of network for all services.
Please see the hospitals impacted at the end of this letter.
What other hospitals are in my health plan network?
We have included a list of alternative hospitals below. Be sure to check the online provider directory at FloridaBlue.com/Medicare or call the number on the back of your member ID card with any questions.
Will this change affect all BayCare providers?
Yes. The in-network status of primary care, specialist, and hospital-based physicians (such as radiologists, pathologists, emergency physicians, and anesthesiologists) employed by BayCare will be affected by this termination.
Will it cost me more to use BayCare if they are no longer in my health plan network?
Except when you need emergency care, urgent care, or dialysis services, our plan does not cover unauthorized care you receive from out-of-network providers. You can look up details specific to your plan in your Evidence of Coverage, which is available on our website, FloridaBlue.com/Medicare.
What happens in an emergency if I go and/or am sent to a BayCare facility because it is the closest to my location?
Under federal and state law, emergency services are unique from other types of care. In the event of a true emergency, Florida Blue Medicare plans will cover emergency services at an out-of-network emergency room.
I am undergoing active treatment with BayCare. How will this affect me?
If we do not reach a new agreement, Florida Blue Medicare will work with BayCare to implement a process to minimize potential disruption for members in active treatment by ensuring continuity-of-care processes that conform to state and federal guidelines.
For questions about continuity of care or for help finding a new quality in-network health care provider, please call the toll-free number on the back of your member ID card or visit one of our local Florida Blue Centers for face-to-face support. To find a nearby Center, visit FloridaBlue.com/Center.
Can I change my Medicare plan?
You can change your Medicare plan during certain times of the year.- Annual Election Period (AEP): From October 15 – December 7, you can join, switch, or drop a Medicare health or drug plan for the following year.
- Medicare Advantage Open Enrollment Period (OEP): From January 1 – March 31, if you are enrolled in a Medicare Advantage Plan (except a Medical Savings Account plan), you can switch plans or return to Original Medicare and join a stand-alone Medicare drug plan.
- Moving out of your plan’s service area
- Wanting to join a plan in your area with a 5-star quality rating
- Qualifying for or lose Extra Help paying for prescription drug coverage.
- Your provider leaving our network may qualify you for a special enrollment period.