ST. JOHNS COUNTY, Fla. — Many people on the First Coast are caught in the middle of a tug of war between hospitals and insurance companies.
Various hospitals are negotiating contract terms with insurance companies, which could result in patients paying more to go to a hospital close to them.
Currently, it's affecting UF Health at Flagler Hospital patients and Baptist Health patients could be next.
Robert Samuels needs surgery, and it’s scheduled for UF at Flagler Hospital in St. Augustine.
He and his wife, Andrea, of St. Augustine Beach received a letter last month from the UF Health Flagler Hospital stating it was negotiating with Aetna which is the Samuels medical insurance company.
Andrea Samuels said, "Well, I was a little shocked and a little upset."
It turns out, UF Health Flagler Hospital and Aetna did not reach a deal. So that hospital is now out-of-network for the Samuels. That means they’ll have to pay more for care if they continue to go there, and the only other in-network hospital for Aetna is an hour away from them.
"Say if you had a hospital bill of let’s say, $20,000," Andrea Samuels said, "my obligation would be $4,000, which is a lot of money for people on a limited income."
That’s not the only hospital and insurance company butting heads. Baptist Health -- which has several hospitals and doctors’ offices on the First Coast -- is negotiating with Florida Blue. Basically, Florida Blue says Baptist is raising the prices too high and Baptist Health says it has to because of rising costs.
First Coast News reached out to both.
Florida Blue told us, "Baptist Health’s new proposed rate increases are well above inflation and what is customary across Florida and the nation."
The statement continued, "Although Baptist Health may claim that Florida Blue does not reimburse them fairly, Baptist Health has in fact received annual increases without issue until now. Baptist Health’s new proposed rate increases are well above inflation and what is customary across Florida and the nation."
Baptist Health wrote, "We have only asked Florida Blue to pay market-based rates, consistent with what they pay other similar health systems. We need a new agreement that accounts for the last few years of being paid at below-market rates while factors outside our control dramatically increased the cost of providing quality care."
If a deal is not reached by September 30, Baptist Health hospitals, physicians, and many other clinical locations will be out of network on October 1. This could impacts wide swaths of the population across the First Coast.
However, Florida Blue told First Coast News that Nemours Children’s Health will remain in network, and medically necessary services at Wolfson Children’s Hospital will still be covered.
As for the Samuels’ situation with UF Flagler Hospital now being out-of-network for Aetna Insurance, they couple just learned Medicare will help cover Robert’s surgery.
But they still have concerns about how this will impact so many people.
Andrea Samuels said, "We’re lucky. We can afford it. But my concern is the community who can’t afford it. The middle class families and lower income families."
First Coast News has also learned UF Health is negotiating with UnitedHealthcare Insurance.
UF Health sent us a statement which read, "It is not certain that UF Health Flagler Hospital and affiliated UF Health providers will be included in United Healthcare’s network after September 1st. At a time when United and other health plans are reporting record profits, hospitals and physicians such as UF Health continue to shoulder significant increases in labor, supplies, and other expenses while we continue to provide excellent care to patients. We are working very hard and in good faith to reach an agreement that provides our hospitals and physicians fair and appropriate rates that will keep UF Health St. Johns in the United network."