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Health insurance at SMHBlue Cross & Blue Shield Update

Negotiating reasonable administrative terms and fair reimbursement rates with insurance companies every few years is standard practice for medical providers. The terms and enforceability of these contracts are essential to Sarasota Memorial's ability to provide a wide variety of high-quality services in the future.

Although Sarasota Memorial and its First Physicians Group (FPG) practices have not yet been able to finalize a contract renewal agreement with Blue Cross and Blue Shield (BCBS), the parties agreed on March 5, 2021, to extend the current contract through June 30, 2021, so they may continue working on outstanding issues.

Talks between the parties are ongoing, and we expect to be able to provide an update on the progress in mid-May. 

BCBS has been a valued partner in caring for our patients since 1994, and SMH is committed to working through our mutual concerns before the current contract expires June 30, 2021.   

While there are many details to discuss, most issues revolve around preserving important provisions in our existing contract that provide access to needed healthcare services for all BCBS members, protect our patients from claim denials and ensure prompt payment for services rendered.

If we cannot reach mutually acceptable terms by June 30, 2021, when the current contract ends, our hospital and complete system of outpatient and urgent care centers — including FPG physicians — will become out-of-network providers for BCBS members beginning July 1, 2021.

Sarasota Memorial’s highest priority is to ensure our community has access to affordable, high-quality, comprehensive medical care. Over the years, SMH has remained true to its public mission as the community’s only not-for-profit, safety-net hospital. Today, we continue to rank among the nation’s top hospitals while providing vital mission services that other local hospitals do not — including a life-saving trauma center, critical care nursery, pediatrics, and maternity services.

We know that BCBS members have concerns. Following is a list of frequently asked questions. Please check back for future updates.

Frequently Asked Questions

What is the primary issue delaying a renewal agreement?

Contracts involve not just rates, but important protections for our patients and community health system. We are confident that BCBS and SMH will do everything possible to reach an agreement that not only protects our patients but also ensures appropriate payment under our agreements. Of greater concern to SMH is ensuring access to our complete hospital system, facilities and physicians. We believe all BCBS members deserve access to all of our services and locations. No plan member should be denied access by BCBS to certain SMH locations or be forced to travel far from their homes to access the care they need.

Are delays in contract renewals serious?

It is normal business practice for hospitals and health insurers to renegotiate and renew insurance contracts every few years. These renewal discussions are intended to address changes since the contract was last reviewed, such as changes in healthcare costs or government reimbursement, improvements in technologies and care, as well as to resolve any operational issues that may have arisen.

We have been working with BCBS for several months to update our existing agreement that provides access for BCBS members to Sarasota Memorial Hospital, First Physicians Group and our system of outpatient and urgent care centers.

While we cannot guarantee that we will be able to reach an agreement, we want to assure you that we remain in active discussions with BCBS and that resolving this issue before it impacts our community and our patients is a top priority.

Which Blue Cross & Blue Shield plans and SMH services would be affected?

If we cannot renew our agreement, Sarasota Memorial Hospital, as well as its system of outpatient and urgent care centers and First Physician Group (FPG) practices, will become out-of-network providers for BCBS members with Medicare Advantage, Commercial and Exchange plans when the contract extension period ends June 30, 2021.

This change would NOT affect patients with traditional Medicare or Medicare supplemental plans.

What happens in emergency situations?

It’s important to note that in emergency situations, out-of-network charges do not apply. Anyone requiring emergency care should go to the nearest hospital. BCBS members have the right to choose Sarasota Memorial’s main campus Emergency Care Center or its freestanding ER in North Port for emergency care.

SMH Urgent Care Centers (UCCs) do not provide emergency care. Members should verify coverage with BCBS before seeking urgent care at any of our 6 UCCs.

What if I’m pregnant? Or need continuing care for an illness or injury?

There are provisions in state law to ensure continuing care at in-network rates for women who are pregnant and for patients in the midst of treatment for certain medical conditions, such as cancer.

BCBS members should work directly with their doctor to coordinate care or call the number on their BCBS ID card. Although there are limitations, Sarasota Memorial will work with patients in these difficult circumstances to ensure they receive the care they need.

Unfortunately, women and children who do not qualify for continuing care benefits likely will be required by BCBS to seek hospital care in another community since Sarasota Memorial is the only hospital in Sarasota County with maternity, inpatient pediatrics and neonatal intensive care services.

What does this mean to my relationship with my FPG doctor?

If we do not reach a renewal agreement with BCBS, Sarasota Memorial’s First Physicians Group also will become “out-of-network” providers when the contract expires June 30, 2021. We will do everything we can to ensure continuity of care for our pregnant mothers and those patients under treatment, or if necessary, to assist in transitioning your care to a new provider.

 

For More Information

Blue Cross & Blue Shield: Call the phone number on your insurance card and let the insurer know how you’ll be affected by losing “in-network” access to your physician, hospital and Sarasota Memorial’s comprehensive continuum of care.

Sarasota Memorial Billing Advocacy Office: If you have questions about how this might impact your ability to seek care at Sarasota Memorial Hospital or our outpatient and urgent care centers, please call SMH’s Billing Advocacy Office at 941-917-1540 or 800-764-2455, weekdays from 8 am to 5 pm.

Sarasota Memorial and its system of outpatient centers and physician practices accept most major medical plans. For more information about accepted plans, please call 941-917-1540 or click here.

First Physicians Group: If you have questions about how this might impact care provided by your FPG physician, please contact FPG’s central office at 941-917-2600, weekdays from 8:30 am to 5 pm.

For more information about FPG and a list of insurance plans it accept, visit its website at firstphysiciansgroup.com.

* NOTE: This webpage was last updated April 19, 2021.