Advocating for affordable health care

You can continue to receive care from your current provider through the end of their contract. 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.

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

In most cases, we can reach an agreement with a provider before the contract ends. 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 July 1, 2025, there should be no concern.

You may be able to establish continuity of care with your current provider at the current in-network benefit level for up to 90 days 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.

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.

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 pregnant women in this situation.

• If you're in your first trimester, you may be able to see your doctor for up to 60 days after they leave our network.
• If you're in your second or third trimester, you may be able to continue care with your current provider for the remainder of your pregnancy and up to 60 days after delivery.

This means you can complete your pregnancy care and postpartum care with your current provider, even if they're no longer in our network. You’ll also receive care at in-network rates for the specified period.

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 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