Advocating for affordable health care

In some cases, members with a chronic condition or in treatment may continue to receive care while paying in-network rates after their provider’s contract ends. This is called Continuity of Care.

Your letter will provide more information on who to contact to learn 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.

If you see a Primary Care Physician (PCP) at Broward Health, the letter you receive will match you to another high-quality local doctor who is in-network. Should you wish to select a different PCP, please contact our customer service teams and we’ll be happy to work with you to choose another doctor.

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

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

You can contact customer service at the number on the back of your member ID card for more information about this process. Call us anytime and we will help answer any questions you may have or provide clarification.

You can easily find and choose other in-network hospitals, physician, or clinical sites in your area by logging into your member account.

In an emergency, members should always seek care at the closest hospital. Care for an emergency medical condition will be covered as in-network (even if the member doesn’t otherwise have out-of-network benefits), though out-of-pocket costs will vary depending on their health plan benefits.

You are covered for emergency services, even at an out-of-network facility. If you are admitted to the hospital after an ER visit, and the hospital is no longer in the network, you are protected. The hospital stay for the emergency is covered at your in-network cost share. This is because the stay is billed as a single claim and subject to consumer protection from the No Surprises Act.  Under the No Surprises Act, you’re also protected from balance billing for emergencies. If you need to return to the out-of-network hospital for non-emergency care, that visit would not be subject to the No Surprises Act. In that case, your out-of-network benefits will apply as outlined in your contract.

If your doctor is leaving our network and you’re pregnant, we'll work with you to ensure you can continue receiving care from them. There are policies in place to protect pregnancy and postpartum care with your current providers and 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 if Broward Health decides 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 network includes many 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. 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, of the bill, including cost shares and deductibles.

Learn more about the types of networks that health plans offer.

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

There are several factors that affect what you may pay for a visit to a provider. If you see a provider that is not in your network, the amount we pay (the reimbursement rate) may be lower, meaning you will have a larger amount that you must pay 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 Florida Blue pays the provider and what is left of the bill.

In general, we are finding that health care 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 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 achieve better health.

We are required by law to spend at least 80-85 cents (the exact amount varies by plan/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