Frequently asked questions
About the negotiation
Our goal is to be as transparent as possible, though specific details, including financial discussions, are confidential.
About the provider network
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.
About health care costs
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 other organizations — 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.
To learn more
To help educate individual and group members about the contract negotiations process, we have developed informational tools that highlight how we work with doctors, pharmacies, and other health care facilities and providers, advocating in the best interest of the communities we serve.
Negotiations between health plans and health care providers can be unsettling for members whose access to care may be impacted — this can cause feelings of uncertainty.
We encourage you to reach out to us if you have any questions or concerns about your coverage or whether a particular provider could be affected.
Just call the number located on the back of your member ID card. We're here to support you and want to make sure you have all the information you need
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