The announcement Tuesday of a new contract between Florida Blue and Baptist Health Jacksonville left some Florida Blue members who use Baptist Health feeling whipsawed when they reacted with relief only to learn the agreement significantly changes their myBlue and Medicare Advantage plans.
The biggest impact is for myBlue members because that particular HMO plan stopped having Baptist Health hospitals and physicians in its network on Tuesday as a result of the new contract.
Florida Blue and Baptist Health said Thursday they agreed to a 30-day transition period for myBlue members who have existing appointments, procedures or medical imaging scheduled at a Baptist Health Jacksonville hospital or physician's office through Oct. 31.
"We encourage patients to keep their existing appointments," the statement said by noting the cost to those patients through the end of October will be at the in-network rate as far as co-pays and cost shares.
The 30-day extension will give breathing space to at least some myBlue plan members scrambling to figure out their next moves.
"It was kind of a whirlwind," said Scott Lowery, whose family has a myBlue plan.
He said the initial news reports of the announcement of a new contract brought some peace of mind. "Our whole family rejoiced. We were like 'Thank God' because we were really worried about that."
The relief didn't last long because he soon learned Baptist Health had canceled upcoming appointments for his family and Baptist Health hospitals and physicians were out of the myBlue plan's network for coverage. He then spent hours trying to understand the options for seeing a doctor and filling prescriptions, often finding the people he called didn't know, either.
"It was frustrating and also really stressful," he said.
Baptist Health hospitals and doctors no longer in myBlue plans
People mainly get the myBlue plan through the Affordable Care Act marketplace that offers tax credits for reducing premiums.
Florida Blue members who get health insurance directly through their employers are not in a myBlue plan and won't be affected by changes to that plan.
"Baptist requested to no longer participate in myBlue, an affordable low-cost HMO product," Florida Blue said. "We are already working to help our myBlue members transition to other quality in-network myBlue providers across Northeast Florida."
The insurance provider said that during the next open enrollment period, myBlue members can switch to a different Florida Blue plan that has Baptist Health in its network, but an alternative Florida Blue plan will cost more.
Baptist Health said that "all hospital care" for myBlue members who are 17 and younger will stay the same with in-network coverage. For adults 18 and older, all hospital care for an emergency admission, labor and delivery, and psychiatric services related to Baker Act admissions will still have in-network coverage through myBlue plans, Baptist Health said.
In addition, the in-network coverage from myBlue plans will continue for "any transfers from a participating hospital" when patients require a "higher level of care not otherwise available," Baptist Health said.
Jacksonville Orthopaedic Institute and Baptist Behavioral Health, which were not part of the negotiations for the new contract, are still in-network for myBlue members.
Navigator program can help people who got insured through ACA
One information source for people who purchased their myBlue coverage through the Affordable Care Act marketplace is to contact the Navigator program that provides free assistance to consumers.
The change to the myBlue plan triggers a provision that allows myBlue consumers to have a special enrollment option for signing up with a different health insurance plan in the marketplace, said Joyce Case, program director for the local Navigator program operated by the Health Planning Council of Northeast Florida.
Case said the change in the myBlue plan would not trigger a published special enrollment period notifying myBlue members of that option. But on a case-by-case basis, myBlue plan members could seek to get a special enrollment option by showing there is "inadequate network" coverage for that plan member's specific needs, Case said.
She said a switch to a different insurance plan through special enrollment would not become effective until Nov. 1. She said those who want to stick with the myBlue plan through the end of the year could select a new plan during the open enrollment period that starts Nov. 1. They would need to pick that new plan by Dec. 15 for it to be in effect starting Jan. 1.
"It's really a difficult situation for the consumers," Case said.
The Navigator program, which is federally funded and certified, provides information about different alternatives consumers have. "We get the lay of the land related to their health and then we go through the different plans with them," Case said.
To make an appointment with in the Navigator program, call (866) 295-5955
Baptist Health primary care not in network for Medicare Advantage plans
In another change, the Medicare Advantage PPO and the Medicare Advantage HMO plans from Florida Blue no longer have primary care providers from Baptist Health in their networks. Florida Blue is matching members of those plans with other primary care providers who remain in network for Medicare Advantage.
Baptist Health said that while Baptist Primary Care will no longer be in network for the Medicare Advantage plans, all emergency, hospital, outpatient and specialty physician services remain in-network for those plans.
Consumers can see if they qualify for "continuity of care" coverage
By law, consumers can continue to get health care services at the same in-network rates they had previously if they meet criteria for what's known as "continuity of care." That would include Florida Blue members who have myBlue and Medicare Advantage plans and qualify based on the treatment they have been receiving.
Florida Blue says continuity of care protections cover people who are in active treatment, such as a patient who is pregnant. Other cases where patients are eligible would be if they are going through treatment or care for "serious and complex conditions" or in post-operative care following surgery.
Florida Blue members who qualify for continuity of care can get that protection for up to 180 days for an HMO plan such as the myBlue plan or the Medicare Advantage HMO plan.
Continuity of care lasts up to 90 days for qualifying members who have a PPO plan such as the Medicare Advantage PPO plan.
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Most Florida Blue plans remained in network
Baptist Health said the majority of Florida Blue plans that had in-network coverage for Baptist Health still have that coverage.
"Most Blue Cross and Blue Shield plans including federal, state, PPO, Indemnity, Simply Blue, Blue Choice, Blue Care HMO, and Blue Options PPOwill continue to be included in our new contract as well as Florida Blue Medicare, HMO and PPO plans," Baptist Health said in a statement. "Both parties agreed to some changes in covered services for Medicare Advantage and myBlue plan members."
(This story was updated to add new information.)
