Florida Blue and Cigna disputes with South Florida hospitals push patients out of network, paying higher costs – Sun Sentinel

Showdowns in Broward and Palm Beach counties between hospitals and insurers like Florida Blue and Cigna over contract terms are pushing patients out of network for coverage and disrupting care as the new year arrives.

Florida Blue and Broward County’s two public health systems, both under the same CEO, still lack a new contract. The months-long impasse between Florida Blue and Broward Health and Memorial Healthcare System has affected as many as 40,000 policyholders who must deal with higher out-of-pocket costs, a disruption in their doctor relationships, and finding ongoing treatment for non-emergency care. Earlier communication from the parties indicated new contracts might be completed by year’s end, but that hasn’t happened.

“We are having ongoing and productive discussions with the leadership teams from Broward Health and Memorial Healthcare System,” Florida Blue spokesperson Jorge Martinez said Tuesday.

In addition, unless Florida Blue reaches an agreement with Cleveland Clinic Weston by March, notices will go out to policyholders informing them that the hospital will be out of network as well, meaning they will not be covered for non-emergency services. For now, Florida Blue members can continue scheduling appointments and receiving care as usual at the Weston hospital.

The inability to negotiate a contract, however, would put Florida Blue policyholders at a significant disadvantage when choosing care. Open enrollment for employer-sponsored health plans has now closed for most companies, forcing them to decide whether to continue with Florida Blue and Blue Cross Blue Shield. Martinez said it’s too soon to know if and how contract disputes affected enrollment choices. Broward’s public health systems have suffered, too, with patients delaying care or finding new providers.

In Palm Beach County, Cigna policyholders are about to lose in-network options, too.

Tenet’s Palm Beach Health Network, which operates six major hospitals, is about to go out-of-network with Cigna on Wednesday. A Tenet spokesperson said that unless an agreement is reached by that Dec. 31 deadline, 1.3 million Florida Cigna policyholders and 13,000 Palm Beach County residents will not be covered for services at its hospitals. Those hospitals are Delray Medical Center,  Good Samaritan Medical Center in West Palm Beach, Palm Beach Gardens Medical Center, St. Mary’s Medical Center in West Palm Beach, and Palm Beach Children’s Hospital in West Palm Beach. Tenet also operates Florida Coast Medical Center in Port St. Lucie.

Non-renewal of Cigna’s contract will put the county’s only children’s hospital out of network, just as Joe DiMaggio Children’s Hospital has gone out of network for Florida Blue policyholders in Broward County.

Cigna’s standoff with Tenet’s Palm Beach Health Network is part of a national contract dispute with Tenet Healthcare facilities and services nationwide. All of Tenet’s hospitals, outpatient care centers, and health system-employed physicians will lose in-network status with Cigna plans.

Patients are increasingly caught in disputes as health insurers and providers disagree on contract terms and the two parties urge each other to stop disrupting medical treatment.

On Tuesday, a Cigna spokesperson said, “Unfortunately, Tenet’s hospitals in Palm Beach are seeking rates that far exceed the rate of inflation on health care services, which would make their hospitals and ambulatory surgery centers much more expensive for patients than other local facilities. We remain committed to negotiating in good faith to reach a fair and reasonable agreement that offers Palm Beach Health Network market-competitive rates and keeps them in our network.”

Cigna noted that it has a robust network of in-network local providers to guide patients who previously have used services at Tenet hospitals.

The breakdown in negotiations between the two health care giants may represent the trend ahead, and the role AI will play.

Tenet  has set up a website for patients to demand that Cigna relent and said that as part of its negotiations, Cigna will not guarantee that a physician, not a computer algorithm, makes decisions about patient care.

“Tenet Healthcare has been negotiating in good faith to keep in-network access to hospitals and providers at the Palm Beach Health Network for our patients,” said  Andrew Lofholm, Communications and Community Relations Manager with Palm Beach Health Network.  “if Cigna ends its contract by December 31, 1.33 million Floridians could lose affordable access to both of the county’s Level I trauma centers and the only children’s hospital in the region. Because Cigna refuses to agree to reasonable terms to guarantee that a doctor, not a computer algorithm or AI, will make meaningful decisions about our patients’ care, families will be faced with paying thousands more or leaving the doctors and hospitals they’ve relied on for years.”

The standoffs over financial terms and reimbursement rates are also infuriating Broward patients who, at one point, were told by Memorial and Broward Health they couldn’t make appointments as Florida Blue policyholders, even if they wanted to self-pay. On Tuesday, Broward Health and Memorial said they would accept Florida Blue patients who want to self-pay in order to continue to see their doctors.

“We welcome any Florida Blue policyholders to continue their care with Broward Health providers,” said Broward Health Vice President of Communications Jennifer Smith. “Patients would need to self-pay or get a single-case agreement from Florida Blue. ”

The law requires hospitals to provide emergency care to patients regardless of whether they are in network.

“Anyone who arrives at our emergency departments will be treated regardless of their insurance status or ability to pay,” Smith said. “If admission is required, we notify the payor, and they decide whether to authorize admission or start transfer to an in-network hospital. But ultimately, it is the patient’s choice where they are treated.”

South Florida patients are upset that they are caught in the conflict between provider and insurer.

“My husband and I have complex medical histories,” Rev. Corrie Montoya of Davie wrote in a letter to the Sun Sentinel. “We have Blue Cross Blue Shield insurance through my employer. Most of our physicians are with Broward Health. We now must find a new primary care doctor and at least eight new specialists. It’s frustrating to have to start over. I can push through, but what I can’t abide is Florida Blue putting my child and all Broward children at risk.”

The breakdown in contract negotiations between health providers and health insurers put South Florida residents like Bob and Gayle Pifer in the position of losing access to doctors they have come to rely on over many decades.

Bob Pifer has been calling and writing Memorial Healthcare and Florida Blue, seeking answers to whether they can continue to see their doctors, and when the contract dispute will be resolved. The couple live in Pembroke Pines and all hospitals nearby, south of Interstate 595, are operated by Memorial. Both see various specialists at Memorial and Gayle Pifer is undergoing cancer treatment. The Pifers said they have been Blue Cross Blue Shield policyholders for more than 40 years, but can’t afford to keep seeing the same doctors.

“We live eight minutes from Memorial West. If we keep going, we could be stuck for the whole bill,” Bob Pifer told the Sun Sentinel. “In my wife’s case, the last infusion was very expensive.”

Plantation resident Andy Greenfield said he has been getting primary care at Memorial for over 30 years. “Because of this impasse, I will be forced to look elsewhere, even for ongoing conditions that Memorial physicians had treated. I don’t understand how so many hospitals can be out of network simultaneously for residents of Broward County.”

South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.