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If there is no agreement by midnight, BayCare hospitals will be off-limits to 152,000 people who use the insurer.
By KRIS HUNDLEY
© St. Petersburg Times, published September 29, 2000
Like plenty of other Tampa Bay area employers, Russell Brandes hopes an agreement is reached by tonight's deadline in contract negotiations between Blue Cross and Blue Shield of Florida and BayCare Health System Inc.
As executive vice president of Cox Lumber in St. Petersburg, Brandes has about 200 employees in Blue Cross and Blue Shield's HMO. And though he's not making any immediate plans to change insurers if the eight BayCare hospitals drop out of the network, Brandes doesn't rule out the possibility.
"If BayCare stayed out of the Blue Cross Blue Shield network for a significant period of time, we'd have to look at it carefully," Brandes said. "But we don't like to change carriers frequently because it's traumatic."
Brandes should know. His company switched to Blue Cross and Blue Shield from Humana less than a year ago.
Change is the name of the game in health care today. Employers switch carriers, employees change jobs, insurers change drug plans and doctors leave HMO networks.
One in six people with private health insurance changed health plans in the one-year period between 1996 and 1997, according to a survey by the Center for Studying Health System Change. Two-thirds of those changes occurred because of a job change or because employers changed coverage.
While employers may review their health plans annually, they usually switch carriers only after months of planning and careful analysis. Don Gaias, a principal with the Towers Perrin consulting firm in Tampa, said most companies stick with an insurer for at least five years.
"Small companies may change more often because they're under more pressure from rate increases," he said. "But it's a big, complicated effort for large companies to change, and it takes a minimum of six months."
The battle of BayCare vs. Blue Cross and Blue Shield may force employers to scramble for alternatives. If the two parties fail to reach an agreement by midnight tonight, BayCare hospitals will be off-limits to the 152,000 members of Blue Cross and Blue Shield's HMO and PPO starting Saturday. The 34,000 members of the insurer's Medicare HMO will lose access to the hospitals on Oct. 31.
Patients could still go to the nearest hospital in an emergency, and state law guarantees pregnant women and other patients in the midst of treatment can stay with the same hospital even if it leaves the network.
Hospitals that would be out of Blue Cross and Blue Shield's network are St. Joseph's Hospital, St. Joseph's Women's Hospital and Tampa Children's Hospital, all in Tampa; Bayfront Medical Center and St. Anthony's in St. Petersburg; Morton Plant Hospital in Clearwater; North Bay Medical Center in New Port Richey; and South Florida Baptist in Plant City.
Members of the network would have 26 hospitals in the bay area, but not necessarily ones that are close to home.
The very public contract battle comes at a bad time for Blue Cross and Blue Shield: Many employers were already reviewing their health plans with an eye to Jan. 1 renewal dates.
St. Petersburg Junior College, which has about 1,000 employees on Blue Cross and Blue Shield's plan, put out a request for bids weeks before hearing of a potential BayCare problem.
At the St. Petersburg Times, another Blue Cross and Blue Shield customer, interim human resources director Jane Peppard said this is the time of year when the company normally reviews its health care options. In an e-mail to the newspaper's employees, the company took a hard-line stance.
"If these hospitals were no longer part of the Blue Cross Blue Shield network, we would consider the network unacceptable," the message read.
Gaias of Towers Perrin said employers could face a dilemma regardless of how the current conflict is resolved.
"If Blue Cross Blue Shield gives BayCare a huge increase, they'll have to go back to employers and say they need higher premiums," Gaias said. "But if BayCare drops out, employees are going to say, "These are the hospitals I use.' It'll be very ugly."
Q: What's happening?
A: Blue Cross and Blue Shield of Florida and BayCare Health System Inc. are in contract talks and continue to disagree over several issues. If they are unable to reach an agreement -- or agree on an extension -- their commercial contract will end tonight at midnight. The Medicare HMO contract will end on Oct. 31.
Q: What does that mean?
A: Members of Blue Cross and Blue Shield's PPO, HMO and traditional health plans would lose access, starting Saturday, to St. Joseph's Hospital, St. Joseph's Women's Hospital and Tampa Children's Hospital in Tampa; Bayfront Medical Center and St. Anthony's in St. Petersburg; Morton Plant Hospital in Clearwater; North Bay Medical Center in New Port Richey; and South Florida Baptist in Plant City. The same hospitals would be off-limits to Blue Cross and Blue Shield's Medicare HMO members on Oct. 31.
Q: What hospitals will remain on Blue Cross and Blue Shield's network?
A: The insurer has agreements with 26 other hospitals in the Tampa Bay area. Among them are many former Columbia (now HCA) hospitals, as well as Mease Countryside and Dunedin. Also on Blue Cross and Blue Shield's network are specialty hospitals such as All Children's Hospital in St. Petersburg and H. Lee Moffitt Cancer Center and Research Institute.
Q: If I'm pregnant, can I still plan on having my baby at a BayCare hospital?
A: By law, Blue Cross and Blue Shield must cover scheduled deliveries even after the contract termination date. Call the insurer's customer service at 1-888-767-8823.
Q: What if I'm in the middle of treatment at one of the BayCare hospitals?
A: Again, ongoing treatments will be authorized by Blue Cross and Blue Shield as required by law. Call the insurer's customer service at 1-888-767-8823.
Q: What do I do if I have an emergency?
A: In case of a genuine emergency, always go to the nearest hospital. Blue Cross and Blue Shield is required by law to cover emergency treatment at any hospital, including a BayCare facility.
Q: Will I have to change my doctor?
A: Your doctor has a separate contract with Blue Cross and Blue Shield that is unrelated to the hospital contract, so doctor's visits will be unaffected.
Q: What if my doctor only goes to BayCare hospitals?
A: Many local doctors also have admitting privileges at non-BayCare hospitals. Doctors who only have admitting privileges to BayCare hospitals can apply for privileges at hospitals that will remain in the Blue Cross and Blue Shield system.
Q: What if I want to change insurers?
A: If you're on a commercial plan, that decision will be up to your employer. At many large local companies, such as Florida Progress Corp., Publix and Eckerd Corp., Blue Cross and Blue Shield is one of several insurance options. In those cases, employees may be permitted to change to a different plan within 30 days. If you're on a Medicare HMO, you can change plans before the 15th of the month for new coverage starting the following month.