Last-minute deal between BayCare, Florida Blue allows 200K to keep doctors – but not everyone is included

TAMPA, Fla. - A last-minute agreement between BayCare Health System and Florida Blue Insurance brought relief to hundreds of thousands of patients across the Tampa Bay area, but not everyone is included. 

What we know:

BayCare Health System announced it had finalized a new contract with Florida Blue just days before their previous agreement was set to expire. The deal ensures that approximately 200,000 patients will continue seeing their BayCare primary care providers without interruption.

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But, that relief doesn't extend to the more than 5,500 Florida Blue Medicare Advantage members who were left out of the deal. They’ll now be forced to find new primary care physicians or a different Medicare plan altogether during the upcoming open enrollment period.

What they're saying:

Dr. Troy Quast, a health economics professor at the University of South Florida, said the failure to reach an agreement on Medicare Advantage plans is particularly striking.

"They had a strong incentive to try to come to an agreement," Quast said. "The fact that they weren't able to on the Medicare side is pretty interesting and shows they're quite a ways apart in the negotiations."

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Quast added that many of the affected seniors could be left making difficult choices with limited time.

"In a short period of time, they have to make this decision of whether they're going to leave their provider, whether they'll leave their insurance company," he said. "It's a tough decision. I think most consumers will opt to find a different insurance company because they are typically happy with their provider."

What's next:

BayCare said that more than 4,000 Florida Blue customers enrolled in the insurer’s Preferred Provider Organization (PPO) plan will still be able to see their BayCare doctors through the end of 2025. But for others, the clock is ticking, with open enrollment set to begin next week.

BayCare CEO Stephanie Conners acknowledged the challenges of the negotiations in a statement to FOX 13:

"Negotiations can be challenging, especially as both parties advocate for those we serve. We negotiated a contract that enables us to continue to provide our region access to the high-quality, compassionate care they expect from BayCare. To make that possible, we negotiated an agreement that reflects today’s health care realities, inflation and ensures BayCare can continue supporting our physicians and providers and our patients."

She added: "The very reason BayCare exists is to care for our patients. We want to assist our Florida Blue Medicare Advantage patients through these changes as they consider next steps, including if they wish to move to a new Medicare plan to keep their BayCare primary care provider."

Florida Blue released the following statement: 

"As the Medicare Advantage industry undergoes significant regulatory and environmental changes, Florida Blue remains committed to prioritizing affordability and accessibility, creating a sustainable health care system that works for everyone. During recent negotiations with BayCare, our goal was to reach a mutually beneficial agreement that balances the needs of both of our organizations while keeping the concerns of our members in mind.

Unfortunately, as part of a mutual decision, not all health plans and products are part of this new agreement, impacting Florida Blue Medicare Advantage HMO and PPO members with a BayCare primary care provider. This decision was made to ensure the long-term sustainability of our Medicare Advantage plans and to maintain our commitment to affordability.

We want to reassure these members that they will continue having access to quality care:

• Members can still see BayCare specialists and hospitals for their care needs.
• Emergency care is always covered for all members and plans.
• Florida Blue Medicare members have a wide choice of quality in-network providers throughout the area.
• Other Florida Blue Medicare plans and members, including those with a Medicare Supplement plan, are not impacted.

We recognize the concern about switching to a new doctor. Our teams are assisting affected members by matching them to a care team specializing in Medicare, close to their home, to minimize disruption. As always, we’re focused on advancing access to affordable health care for all the communities we serve."