bcbs and baptist health negotiations impact jacksonville community

The negotiations between BCBS and Baptist Health have significant implications for the Jacksonville community. The two parties have been discussing a new contract that would affect the health insurance coverage and medical services available to residents.

BCBS has been a major player in the Jacksonville health insurance market for years, and a change in its contract with Baptist Health could impact thousands of policyholders. Baptist Health is a prominent healthcare provider in the area, with several hospitals and medical facilities.

The community is closely watching the negotiations, as the outcome will affect access to quality healthcare for many residents. The contract between BCBS and Baptist Health has been a key factor in determining the availability of medical services and health insurance options in the area.

The negotiations are ongoing, but one thing is clear: the outcome will have a lasting impact on the Jacksonville community.

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Baptist Health is seeking a five-year contract with BCBS to ensure financial certainty, but Florida Blue prefers a one-year deal.

The hospital's leadership claims that the pandemic has led to a surge in demand for services, exacerbating pressures on the health system and driving up costs.

Inflationary costs of prescription drugs and supplies continue to rise, with a 21% increase in prescription drugs and 22% increase in supplies since 2021.

Florida Blue executives say the requested contract increase is nearly twice what they anticipated, with a "high single-digit" increase in costs year-over-year.

The health care industry is expected to see an 8% increase in medical prices next year, according to PricewaterhouseCoopers' Health Research Institute.

Residents of Jacksonville and Nassau County are facing a potential disruption in their healthcare due to the ongoing negotiations between Florida Blue and Baptist Health. If an agreement isn't reached, all Baptist hospitals in the area will be taken out of Florida Blue's network.

This means that patients who rely on Baptist Medical Center in downtown, Baptist Medical Center Beaches, Baptist Medical Center South, and Wolfson Children's Hospital in Jacksonville, as well as Baptist Medical Center Nassau in Nassau County, will have to pay out-of-pocket for treatment if they want to continue using Baptist Health hospitals and physicians.

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The loss of in-network status will affect not just hospital care, but also primary care, specialist, and hospital-based physicians who work for Baptist Health. This includes doctors and medical staff who provide essential services to the community.

The negotiations started in February, with both sides trying to reach an agreement on a new contract that would determine reimbursement amounts. However, the talks have stalled, and the deadline for a resolution is looming.

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About 14,000 of Florida Blue's members have Affordable Care Act insurance.

These individuals are mostly low-income and vulnerable in their community, as noted by Jenkins.

The Affordable Care Act opened the door to affordable health insurance, according to Dr. Rogers Cain and Kenneth Jones of the Northeast Florida Medical Society Foundation.

Even if talks for a new contract between Florida Blue and Baptist Health are not successful, medical services not covered by the current negotiations would continue to be covered by Florida Blue-issued Affordable Care Act policies.

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These services include office-based and virtual Baptist Behavioral Health visits, as well as several other specialized care services.

Visits to Baptist Health and Wolfson Children's hospital emergency rooms and free-standing emergency rooms will not be affected by the outcome of the negotiations.

In some cases, patients can keep getting "continuity of care" treatment at Florida Blue's current in-network rates after Sept. 30 from Baptist hospitals and physicians, even if there isn't a new contract.

Florida Blue determines which patients are eligible for this treatment, and examples include active cancer treatment, pregnancy, and scheduled non-elective surgery.

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As a myBlue member, you're likely wondering what this change means for you. As of October 1, members with a myBlue plan no longer receive in-network cost share for Baptist Health services.

Emergency care is always covered at the in-network cost share, so if you're experiencing an emergency, you should go to the closest ER.

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myBlue members who are in active treatment for serious and complex cases with Baptist Health or Wolfson Children's Hospital providers can continue to see their Baptist Health care team through Continuity of Care.

This Continuity of Care entitles eligible members to receive care at the in-network cost share for up to six months, or until March 29, 2025. You can contact Florida Blue's customer service with any questions about Continuity of Care or for help getting the care you need.

Nemours Children's Health is an independent physician practice and remains in-network for myBlue, so you can still receive care from them.

You can also switch to a different Florida Blue plan that includes Baptist Health in the network during the upcoming open enrollment period.

Here are some alternative healthcare options available to myBlue members:

If you need to speak with someone in person about your options, you can visit a Florida Blue Center near you to speak with a customer care representative.

Florida Blue and Baptist Health are currently negotiating a new contract, which could affect the hospital's network status with Florida Blue.

The negotiations started in February and have been ongoing. Florida Blue says that if an agreement is not reached, all Baptist hospitals in the Jacksonville area will flip from being in-network to out-of-network, affecting patients who want to continue using Baptist Health hospitals and physicians.

Florida Blue is pushing for a three-year contract, while Baptist Health wants a multi-year contract with market-based reimbursement rates. Baptist Health claims that Florida Blue is paying them less than other hospitals in the state, which they believe is unfair.

Florida Blue says its offer to Baptist Health represents a fair market value that accounts for inflation and higher labor costs.

Florida Blue and Baptist Health are locked in negotiations over a new contract, with a key sticking point being the proposed rate increase. This increase would bring more than 70% increases over the next four years, adding over a billion in increased community health costs.

Jenkins, a representative from Florida Blue, acknowledges that the company has negotiated increases with other hospital systems in the state to account for annual inflation and increased labor expenses. However, Baptist Health disputes this perspective, claiming that it does not plan to ask for such a large increase.

Baptist Health's Groover says that research and development always come at a cost, and that new treatments and technologies will continue to drive up healthcare expenses. This is reflected in the fact that preventative services have decreased since March 2020, leading to more patients requiring critical care when they do finally seek treatment.

The negotiations have a significant impact on patients, with Florida Blue warning that if an agreement is not reached, all Baptist hospitals in the Jacksonville area will be removed from its network. This means that patients would have to pay out-of-pocket for care at these hospitals, which could be a significant burden.

Baptist Health claims that Florida Blue is paying it less than other hospitals in the state, which is unacceptable. Jenkins counters that Florida Blue's offer represents a fair market value that accounts for inflation and higher labor costs.

Florida Blue's Jenkins says that the company wants to ensure it is consistent and comparable with other systems around the state, but Baptist Health disputes this, claiming that the proposed rate increase is not accurate.

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Baptist Health has established relationships with major insurance companies in the region, allowing patients to receive care at Baptist Memorial Hospital for Women and the Spence and Becky Wilson Baptist Children's Hospital.

These hospitals are in-network providers for various insurance companies, making it easier for patients to access care without worrying about high out-of-pocket costs.

Accepted insurance networks include Blue Cross and Blue Shield, which is a major player in the region's healthcare market.

Patients can rest assured that their care will be covered by their insurance provider at these hospitals.

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