Advocating for you

In some cases, members with a chronic health 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.

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 by calling the number located 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. Or call us at the number on the back of your member ID card. 

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 can still go to Memorial Healthcare System for emergency care.  Out-of-pocket costs will vary depending on their health plan benefits.

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 Memorial 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 Memorial Healthcare System 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 the Memorial 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 the Memorial 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 your doctor is leaving our network and you’re pregnant, we'll work with you to make sure 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 after the September 1 deadline, meaning 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. 

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. 

Absolutely. We’re diligently negotiating with hospitals and drug makers, guiding members to lower-cost options, and guiding members toward generics that are just as effective. But we can’t fix this alone. We need a system-wide effort—public and private—to take on the affordability crisis and protect families from rising costs.

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.