Advocating for you

You can continue receiving care from your current provider through the end of the contract. In some cases, members who are pregnant or have a chronic health condition or are in active treatment may continue to receive care for a period of time while paying in-network rates after their provider’s contract ends. This is called Continuity of Care.

Your letter will provide more information on how you can continue your present course of treatment with your current provider. It will also provide information on how to find a new provider. 

In most cases, you do not need to find a new care team right now. We’re required to send notification letters about the possible contract termination, in most cases, 45 days before the contract ends.  

Typically, we can reach an agreement with a provider before the deadline. If a new agreement is reached, we will notify you that your provider is remaining in the network. 

If you have an upcoming appointment scheduled ahead of October 1, 2025, there should be no concern. 

If you are receiving treatment for a covered complex or chronic medical condition, you may be able to continue care with your current provider at the same in-network benefit level for a period of time. Such conditions include pregnancy or scheduled nonelective surgery. 

There are state and federal protections and details on who qualifies for Continuity of Care and the length of time for covered care. 

For more information on this process, you can contact customer service by calling the number located on the back of your member ID card.  

You can easily find and choose other in-network hospitals, physicians, or clinical sites in your area by logging into your member account. Or call us at the number located on the back of your member ID card. 

In the event of a true emergency, ER and emergency services are covered, even at out-of-network facilities. This means you can still go to a BayCare ER. Out-of-pocket costs will vary depending on your health plan benefits. In an emergency, members should always seek care at the closest hospital.  

Under federal and state law, emergency services are unique from other types of care. In the event of a true emergency, ER and emergency services are covered, even at out-of-network facilities, so you could still go to BayCare for emergency care. 

All Commercial members 

• Florida Blue plans cover emergency services for Commercial members at an out-of-network emergency room at the in-network cost share.  
• If you’re admitted to a BayCare hospital after a visit to their ER, even if the hospital is no longer in the network, the hospital stay for that emergency is covered at your in-network cost share. 
• A subsequent visit to the hospital, outside of the emergency, would not be covered at the in-network cost share. 

Medicare HMO members 

• Florida Blue plans cover emergency services for Medicare HMO members at an out-of-network emergency room at the in-network cost share.  
• If an HMO member is admitted after a visit to a BayCare ER, even if the hospital is no longer in the network, the hospital stay for that emergency is covered at their in-network cost share until the member’s health is stable. 
• Florida Blue will then work closely with the member and their health care team to coordinate a transfer to an in-network hospital, so the member can continue receiving the care they need without any gaps or disruptions. 

Medicare PPO members 

• Florida Blue plans cover emergency services for Medicare PPO members at an out-of-network emergency room at the out-of-network cost share.  
• If a PPO member is admitted after a visit to a BayCare ER and they are no longer in the network, the cost for the hospital stay for that emergency will be at the out-of-network rate. 
• Once the member’s health is stable, we’d work closely with the member and their health care team to coordinate a transfer to an in-network hospital if they preferred to be cared for at an in-network hospital. 

If you’re pregnant and your doctor is leaving your provider network, you can continue receiving care from them. There are policies in place to protect pregnancy and postpartum care with your current care team. 

• For expectant moms with an HMO plan, your care from your provider will be covered by your in-network benefits. 
• For those with a PPO plan, you can still use your in-network coverage for 90 days should BayCare decide to leave the network, and then your care is covered by your out-of-network benefits. 

We’re committed to ensuring our members have access to the care they need. Our networks include many local providers that share our commitment to high-quality, cost-effective care. This includes high-quality hospitals, doctors, specialists, labs, and facilities in your neighborhood and throughout the area. 

A provider network includes the doctors, specialists, hospitals, labs, pharmacies, and other medical professionals that are part of your health plan. Not all health plans have the same provider network. We negotiate rates with these providers, so you get high-quality care at the lowest possible prices. Choosing in-network care saves you money.  

An in-network provider currently has a contract with Florida Blue, and when you see them, you are typically only responsible for cost shares and deductibles. Because they’ve agreed to prices with your health plan, you pay less when you visit them. It’s like having a member discount card for your health care. We cover more of the costs for in-network providers. 

An out-of-network provider does not have a contract with Florida Blue, and you may be responsible for most, if not all the bill, including cost shares and deductibles.  

Learn more about provider networks and negotiations. 

Our customer service team can also help you understand the difference between in-network versus out-of-network benefits and more. 

When you visit a provider, there are several factors that can affect what you may pay. If you see a provider that is not in your network, the amount that your insurance pays (the reimbursement rate) may be lower, meaning you will have to pay a larger amount out of your pocket. 

If you have a plan with a deductible and have not met your annual deductible, you may pay the difference between the negotiated contract rate your health plan pays the provider and what is left of the bill. 

In general, health systems bill health insurance plans more to make up for the lesser amount they receive for Medicaid and Medicare reimbursements. In other words, employer-sponsored health plans and plans purchased by individuals subsidize other lower paying types of plans. 

Florida Blue is mission-driven to help people and communities achieve better health at a price they can afford. Unlike a for-profit organization — whose goal is making money for investors — we’re helping people and communities live their healthiest life.  

We are required by law to spend at least 80-85 cents (the exact amount varies by product) of every premium dollar directly on the care of members, and we exceed that by putting policyholders’ money where it matters: their health. 

The main drivers of rising health care costs are the direct costs of medical care — a combination of prescription drugs and services provided by hospitals, doctors, and medical facilities. 

Advocating for access and affordability in these negotiations is our responsibility.  

We’re reinvesting our profits to enhance our capabilities and better support the well-being of our members and communities.