Florida Blue dispute leaves patients driving hours for in-network care

A contract dispute between Florida Blue and several major hospital systems in Broward County, Florida, is leaving patients scrambling for care and facing potential out-of-network costs. The dispute, which began last year, has left tens of thousands of Florida Blue members without in-network access to hospitals like Memorial Healthcare System and Broward Health, and now threatens access to Cleveland Clinic facilities as well.

The situation came to a head for Christina Underwood of Fort Lauderdale in mid-January when her 13-year-old daughter, Harper, experienced a medical emergency requiring immediate attention for a potentially bursting appendix. Normally, Underwood would have taken Harper to the pediatric emergency room at Broward Health Medical Center, just three miles from their home. However, due to the contract dispute, that option was no longer available within her insurance network.

Underwood ended up driving nearly an hour north to West Boca Medical Center, where Harper was initially evaluated. Due to a lack of available surgeons, Harper was then transferred by ambulance to St. Mary’s Medical Center in West Palm Beach, adding another hour to the journey. The ordeal, which concluded with Harper receiving a patient room at 5 a.m. And a scheduled surgery at 11:30 a.m., highlights the challenges patients are facing in accessing timely and affordable care.

A Prolonged and Unusual Dispute

The core of the issue lies in reimbursement rates. Both Memorial Healthcare System and Broward Health accuse Florida Blue of not adequately compensating them for the care they provide. Florida Blue, in turn, contends that the hospitals are demanding excessive payments. Jason Buxbaum, an assistant professor of health services, policy, and practice at Brown University, described the situation as “a really exceptional and unusual dispute to go on this long.” He noted that while contract negotiations between hospitals and insurers are common, the duration of this particular dispute is noteworthy.

Buxbaum suggests increased transparency in healthcare pricing, driven by federal regulations, may be contributing to more aggressive negotiations and public disputes. He cautions that patients are often caught in the middle of these negotiations, experiencing inconvenience and uncertainty.

Hospital Perspectives

Memorial Healthcare System expressed its disappointment with the situation, stating that Florida Blue’s decision would cause hardship for patients. The hospital system also claims Florida Blue owes over $150 million in outstanding claims for care provided to its members over the past five years. Florida Blue did not directly address this claim in its public statements.

Broward Health echoed these concerns, stating that it has repeatedly offered compromises to reach a fair agreement with Florida Blue. The hospital system also accused Florida Blue of declining offers to involve a third-party mediator in the negotiations.

Florida Blue’s Position

David Wagner, South Florida market president of Florida Blue, acknowledged the difficulties patients are facing and expressed optimism that a resolution can be reached. However, he emphasized that the dispute centers on affordability, with Florida Blue arguing that the hospitals’ requested reimbursement rates are unsustainable. The insurer claims that Broward Health is seeking a 60% increase in rates, which would translate to over $150 million in higher healthcare costs for members.

Florida Blue also raised concerns about potential “surprise bills” stemming from increased charges at Memorial Healthcare System, alleging that the hospital has a practice of raising prices without justification. Memorial disputes these claims, asserting its commitment to transparency and adherence to contractual obligations.

Impact on Patients

The contract dispute is impacting a significant number of patients. Florida Blue estimates that nearly 60,000 policyholders who received care at Memorial or Broward Health in 2025 are affected. However, the actual number may be higher, including patients who have not yet sought care at these hospitals. A recent survey conducted by the Miami Herald revealed that patients are struggling to find new in-network doctors, are driving longer distances for care, or are paying out-of-pocket to continue seeing their preferred providers.

Anna Mae Dominguez, a Broward County resident, has been a Florida Blue member for decades. While she hasn’t had to change doctors yet, she worries about the potential for disruptions in care and the increasing difficulty of navigating the healthcare system. She questions whether the benefits of her insurance plan still outweigh the challenges of limited network access.

Kara Skorupa, a longtime Memorial patient undergoing cancer treatment, expressed frustration with the situation, describing it as a “lunacy” that a hospital-based physician group can’t access the hospital where they work. She has been forced to seek care at Mount Sinai Medical Center, which is in-network, but misses the familiarity and trust she had with her previous care team.

Navigating the Challenges

Florida Blue is encouraging members to seek care at alternative in-network facilities, such as Holy Cross Fort Lauderdale, HCA Florida hospitals, and Sanitas Medical Centers. However, patients are facing logistical challenges and emotional distress as they navigate these changes. The situation is further complicated by the potential for Cleveland Clinic to leave Florida Blue’s network in early March, adding another layer of uncertainty for patients.

The ongoing contract dispute underscores the complexities of healthcare financing and the importance of collaboration between insurers and providers to ensure access to affordable, high-quality care. As negotiations continue, patients remain caught in the middle, hoping for a swift and equitable resolution.