RIVERVIEW, Fla. — With simply months left in his daughter’s chemotherapy remedies, John Feely mentioned he bought a latest shock that felt all too acquainted.
It was a letter from BayCare Health System—letting sufferers and their households know that they are at present within the midst of heated contract negotiations with insurance coverage supplier Florida Blue. The letter goes on to say that if the 2 cannot attain an settlement by the tip of September, come October 1, Florida Blue will not be accepted within the BayCare community.
The Feelys mentioned they’ve skilled this earlier than, with a distinct insurance coverage supplier throughout 7-year-old Selah’s first cancer prognosis just a few years in the past.
“My wife and I looked at each other and we were just like ‘really, is this really going to happen again,'” mentioned John Feely, “To be honest we were still trying to sort through the issues that remained from 2019 to 2020.”
As a end result, a change.org petition shortly sprung up on Selah’s behalf—calling for the 2 to return to an settlement so her remedies can proceed to be coated.
Christina Feely
And Feely mentioned the eye has led to calls from each with a suggestion to both preserve their insurance coverage and alter hospitals or ditch their insurance coverage for one more supplier 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,” mentioned John Feely.
John provides that there’s additionally a 3rd choice—BayCare and Florida Blue are working to supply a “continuity of care” plan for sufferers nonetheless in the midst of sure remedies. This would run anyplace from three to 6 months, relying on the patient’s plan, and lock in protection and present costs for care.
In Selah’s case, John mentioned she qualifies for the 3-month choice. And her household hopes to make use of that care plan to complete up her chemotherapy remedies, in hopes that by the point they’re achieved Florida Blue and BayCare would have come settlement that works for 1000’s of sufferers like Selah.
“I do feel like the people on both sides truly want to help,” mentioned John Feely.
ABC Action News reached out to each Florida Blue and BayCare for a greater understanding of how they bought right here.
Here’s what BayCare needed to say:
BayCare nonetheless has a contract to serve Florida blue clients, and now we have been working laborious over the past a number of months to achieve a brand new, honest settlement with Florida Blue earlier than Sept. 30, the date the present contract sunsets. We very a lot wish to attain an settlement that protects sufferers’ potential to proceed selecting the hospitals, laboratory providers and physicians they know and belief at BayCare.
BayCare is asking Florida blue to place sufferers first and negotiate a accountable settlement in order that we are able to entice and retain caregivers and put money into new medical expertise to enhance patient outcomes and expertise. BayCare is a not-for-profit group. We are dedicated to reinvesting in patient care and the caregivers who present it.
Every yr, Florida Blue asks its members and employers to pay extra for his or her medical health insurance protection, however these will increase usually are not proportionately shared with well being care suppliers like BayCare.
Instead, insurers like Florida Blue are shifting the price of care to sufferers by demanding greater premiums and deductibles. Patients typically discover that, despite the fact that they pay excessive month-to-month premiums for medical health insurance, their insurance coverage firm nonetheless requires them to shoulder a big portion of their price of care.
It can be vital to know there are provisions required by legislation in these conditions that shield sufferers in lively therapy. “continuity of care” advantages enable sufferers to proceed to see their trusted suppliers by lively therapy. To apply for continuity of care advantages, sufferers must contact Florida Blue straight.
For extra information, together with solutions to regularly requested questions, please go to keepbaycare.org
– BayCare
Here’s what Florida Blue launched:
BayCare well being system notified us that they wish to terminate their present contract with Florida Blue and begin negotiations on a brand new contract. We have been working with them since February 2022 in hopes of reaching a brand new settlement.
Unfortunately, BayCare is demanding extraordinarily giant will increase within the quantity they’re paid to care for our members. The will increase demanded by BayCare well being system whole greater than $80 million in extra prices that our Tampa bay members must pay every year – along with their present premiums and out-of-pocket prices.
We can’t presumably put this extreme burden on the individuals and companies in Pinellas, Pasco, Hillsborough, and Polk counties. Quality well being care is barely helpful to the neighborhood if the households and people who stay there can afford to entry it.
Florida Blue is providing BayCare aggressive contract phrases with a significant improve in what we pays for providers underneath our present settlement. We are upset and stunned that they count on an exorbitant fee hike that might impression the whole neighborhood.
Additionally, BayCare is demanding contract phrases that would supply no accountability on their half to work collaboratively with us to make sure the providers and procedures they’re recommending and performing are coated by their sufferers’ well being plan advantages.
Because of this, now we have not but reached an settlement. And if we’re unable to, BayCare well being system will withdraw all its amenities, docs and different providers from our Florida Blue community starting October 1, 2022.
We are persevering with to barter with BayCare in hopes that they are going to rethink their place and stay within the Florida Blue networks.
Here is an replace on continuity of care:
We try to work with BayCare well being system to develop continuity-of-care processes to assist decrease potential disruption for our members in the midst of lively therapy, for circumstances similar to being pregnant, surgical procedure and follow-up care, bodily remedy, radiation oncology, and chemotherapy. Continuity of care permits our eligible members receiving lively therapy from BayCare well being system to proceed their therapy on the identical out-of-pocket prices – even when BayCare exits Florida Blue’s networks. The size of time continuity of care is on the market varies by the kind of well being plan a member has in accordance with the state and federal tips.
Florida Blue members shouldn’t must do something to request continuity of care advantages. We will analyze medical claims to determine who has used BayCare well being system over the previous 90 days. This will assist us decide which Florida Blue members could also be in lively therapy for a critical or complicated medical situation and are eligible for continuity of care, and we are going to attain out to these members straight earlier than October 1.
For extra in-depth information, right here is the listing of standards for members to qualify for continuity of care:
- Undergoing a course of therapy for a critical and sophisticated situation from a BayCare supplier or facility;
- Undergoing a course of institutional or inpatient care from a BayCare supplier or facility;
- Scheduled to endure nonelective surgical procedure from a BayCare supplier, together with receipt of postoperative care from a BayCare supplier or facility with respect to such a surgical procedure;
- Pregnant and present process a course of therapy for the being pregnant from a BayCare supplier or facility; or
- Is or was decided to be terminally in poor health (as decided underneath part 1861(dd)(3)(a) of the social safety act) and is receiving therapy for such sickness from a BayCare supplier or facility.
We are encouraging our members to additionally go to https://www.floridablue.com/negotiatingforyou.
– Florida Blue