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Blue Cross & Blue Shield Community Update

(March 8, 2018) — Ensuring that our community has access to affordable, high-quality, comprehensive medical care is Sarasota Memorial Health Care System's top priority. Sarasota Memorial has become one of America’s best hospitals — and one of the most respected — while remaining true to its public mission as the community’s only not-for-profit, safety-net hospital. We provide vital mission services that other local hospitals do not — including a life-saving trauma center, critical care nursery, pediatrics, maternity and more — at charges far below our surrounding for-profit hospitals.

Negotiating fair reimbursement rates with insurance companies, such as Blue Cross and Blue Shield (BCBS), every few years is standard practice for medical providers and is essential for Sarasota Memorial to provide high-quality services in the future.

SMH and its First Physicians Group (FPG) network have made considerable progress in their talks with BCBS, and we're optimistic that a contract renewal agreement will be reached in the coming weeks. However, two key issues must first be resolved. The first is safeguarding our existing contract's provisions that protect SMH, FPG and our patients from claim denials and disputes and that ensure prompt payment for services rendered. We also have asked for a modest rate increase for our FPG physicians — it would be their first in more than five years.

If we cannot reach mutually acceptable terms by March 31, 2018, Sarasota Memorial and its complete network of outpatient and urgent care centers, including FPG physicians, could become out-of-network providers for BCBS / Florida Blue members on April 1, 2018. We encourage you to reach out to BCBS and let the insurer know how you would be affected should SMH and FPG become out of your network. You can call BCBS at 1-800-352-2583 or the phone number listed on the back of your insurance card. 

Several weeks remain before the current contract expires on March 31, 2018. While we cannot guarantee that we will reach an agreement with BCBS tomorrow or even next week, we are not in an impasse situation. We are in active discussions with BCBS, making steady progress each day, and we are hopeful that there will not be any disruption to patient care. We value our patient relationships and are diligently working with your best interests in mind.  

Frequently Asked Questions

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

If we do not reach an agreement, on April 1, 2018, Sarasota Memorial Hospital, as well as its network of outpatient and urgent care centers and First Physician Group (FPG) practices, will become out-of-network providers for BCBS members with the following plans: Medicare Advantage, Commercial, Exchange, Federal and all independently licensed out-of-state plans.  

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 six 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.

How serious is this dispute? Could it be resolved in the coming days?
It is normal business practice for hospitals and health insurers to renegotiate and renew insurance contracts every few years in order to reflect rising healthcare costs, changes in government reimbursement, and improvements in technologies and care.    

We have been working with BCBS for several months to update our existing agreement that reimburses us for services provided to BCBS members by Sarasota Memorial Hospital, First Physicians Group and our network of outpatient and urgent care centers. 

Although we have made progress, fewer than 30 days remain until our current contract expires on March 31. There are two key negotiation hurdles that are critical to the long-term success of our relationship with BCBS. First, BCBS pays less than every other major insurance carrier for the same services. BCBS recognizes that and has taken steps toward solving the problem — but more work is necessary to ensure their reimbursement rates are competitive and comparable to other insurance companies. 

Equally concerning are foundational changes to our contract structure that BCBS is requesting. Their requested language would put Sarasota Memorial at a disadvantage in claim and contract disputes and strip away provisions that protect our right to be reimbursed for services rendered. 

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

What does this mean to my relationship with my FPG doctor? 
If we do not reach an agreement with BCBS by March 31, 2018, Sarasota Memorial’s First Physicians Group also will become “out-of-network” providers on April 1, 2018.  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.  

Is there anything I can do to change BCBS’s decision? 
You can help by voicing your concerns: Reach out to BCBS at 1-800-352-2583.

Commercial and Exchange plan members: If you are a member of a Commercial or Exchange plan underwritten by Blue Cross and Blue Shield, including federal or state plans, call 1-800-352-2583 or the number on your BCBS insurance member card, or talk with your employer to express your concerns. Let them know how you and your colleagues are being affected, and why you feel it is important that Sarasota Memorial and FPG remain part of your covered network.  

Medicare beneficiaries: Medicare beneficiaries enrolled in or considering BCBS’s Medicare Advantage plans should understand that Sarasota Memorial Hospital, First Physicians Group and SMH’s network of outpatient and urgent care centers might be removed from BCBS’s approved network as of April 1, 2018.  

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

If having SMH or FPG as “in-network” providers is important to you, please consider choosing traditional Medicare and a Medicare supplement plan during open enrollment. If choosing a different plan, such as Medicare Advantage, verify with the insurer that Sarasota Memorial Health Care System and/or First Physicians Group are in its approved network. 

You can learn more about Medicare plan options by calling or meeting one-on-one with volunteer counselors with the Florida Department of Elder Affairs’ SHINE (Serving Health Insurance Needs of Elders) program. SHINE services are free, unbiased and confidential. Call the Florida Elder Helpline at 1-800-963-5337, or visit  

Additional Contacts 

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 network of outpatient centers and physicians 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