Frequently Asked Questions

A: When a hospital partners with an insurance company to accept the plans the insurer offers, the health system becomes part of the insurance company’s “network” and both parties agree to the amount the insurance company will pay the health system for patients who are covered by those insurance plans. After caring for a patient, the hospital bills each patient’s insurance company for services, and the insurance company pays the hospital for the patient’s care based on the rates that were established in the contract. The amount an insurance company pays a hospital or health system for patient care services is called a payment rate, or a reimbursement rate. Currently, Florida Blue is paying our community hospital significantly less than other hospitals. 

A: Because the cost to provide patient care has increased substantially, the payment rate, or reimbursement rate, insurance companies pay hospitals must also increase, which is why NCH is negotiating our contract with Florida Blue: to increase the reimbursement rates to sustainably cover the cost of patient care and help ensure our hospital system remains accessible for the community who trust and depend on us for high-quality care. 

Right now, due to inflation and remaining impacts from the pandemic, hospital systems across the country are facing unprecedented financial challenges, and the cost to provide patient care is becoming unsustainable. Florida Blue is paying NCH less than other hospitals in our region for the exact same services, even though our cost to provide patient care is similar. These payments from Florida Blue do not sufficiently cover the rising costs of providing patient care. We are proud to be here for our patients when and where you need us, and we always want to be.  

A: It’s important to understand that insurance companies are profit driven. Even “not-for-profit” insurance companies realize significant profits. Florida Blue reported $14 billion in revenue in the first half of 2023 alone, while hospitals like NCH continue to weather financial challenges. Because the goal of an insurance company is to earn as much profit as possible, they are incentivized to pay hospitals as little as possible, while still keeping them in-network. Florida Blue is using their size and dominance to underpay our independent, local hospital.

Unlike insurance companies, the goal of our organization and other community hospitals like us, is to cover the cost of patient care, keep our doors open, and thoughtfully evolve to meet the ever-changing and growing needs of our community and patient populations.

These are very different goals: insurance companies are accountable to their various stakeholders for generating profit. Hospitals are accountable to our patients and their families for their health and the health of our community. Our community hospital system is not profit driven.  We exist to take care of people.  

A: If Florida Blue does not agree to a fair resolution, NCH will be forced out of network as of September 30, 2024.

A: No. It is up to Florida Blue to decide whether they choose to prioritize their customers – our patients – over profit, and whether they decide to hand cost down to their customers. Florida Blue reported $14 Billion in revenue in the half of 2023 alone. They are the 3rd most profitable Blue Cross program, while hospitals like NCH continue to weather financial challenges. Florida Blue is using their size and dominance to underpay our independent, local hospital, and by making this statement, it is clear they choose to hand costs down to patients and instead, protect their profit margin. Together, let’s hold Florida Blue accountable to you as their customer, and us – as a true partner and a critical healthcare provider to our community.Unlike insurance companies, the goal of our organization and other community hospitals like us, is to cover the cost of patient care, keep our doors open, and thoughtfully evolve to meet the ever-changing and growing needs of our patient populations. We’re a true nonprofit and our ask of Florida Blue is data and fact-driven. Insurance companies with astronomical profits cannot say the same.

A: We are dedicated to high-quality, cost-effective care. Not only is our dedication proven in the outcomes our patients experience every single day – it’s proven in the unbiased recognition we continue to receive from credible organizations like Healthgrades, as one of America’s Top 100 Hospitals. The level of quality, expertise and value we bring to the health of our community is not in question. What is in question, is Florida Blue’s willingness to accept the facts and be an accountable, fair partner to us and most importantly, an insurance company that acts in the best interest of their members.

A: The negotiation impacts all commercial, Medicare Advantage, and Exchange Florida Blue health insurance plans.

A: Yes, except for Medicare Supplement plans, all Blue Cross and Blue Shield plans would be affected by this negotiation. Even though the negotiations are with Florida Blue, access for all Blue Cross Blue Shield plans, except Medicare Supplement plans, would be impacted when our contract expires on September 30, 2024. At that time, NCH will be considered an out-of-network provider for all patients with Blue Cross Blue Shield health insurance. Contact Blue Cross Blue Shield at the number on your insurance card if you are unsure if or how your plan will be affected.

A: All NCH facilities and providers, including ProScan NCH Imaging, are impacted by this negotiation.

A: While our goal has always been to resolve the negotiation collaboratively and as quickly as possible to help avoid any impact for our patients, Florida Blue took over three months to respond to our last proposal. The current contract ends September 30, 2024. At this time, it does not appear Florida Blue is willing to agree to fair terms, and we expect the contract will terminate. Patient advocacy can help make a difference – we encourage you to call Florida Blue at the number on the back of your insurance card and request that your NCH providers remain in-network.

A: If Florida Blue does not agree to fair terms by September 30, 2024, NCH will be out-of-network, which means that the hospital system and NCH will no longer have a shared agreement and Florida Blue will force many patients to pay higher out-of-pocket costs if they choose to continue to see their NCH doctors and care teams. We encourage you to call Florida Blue to learn what your out-of-pocket costs will be if NCH is forced out-of-network. This is not an outcome we want.

A:  If we are unable to reach a resolution by September 30, 2024, NCH will be considered an out-of-network provider for patients with Florida Blue health insurance. This means most patients will be forced to pay more out-of-pocket if they choose to continue to see their NCH doctors and care teams, change doctors, or drive hours for in-network services.

Alternatively, if you have the option to change health plans during open enrollment this fall, you can explore other insurance plans which include NCH in-network and meet your family’s needs. 

A: Talk to your broker. Choosing the right insurance is crucial for access to high-quality healthcare close to home. Ask about plans that maintain your in-network access to NCH. You can find a full list of the insurance plans we accept here.

A: You will always have access to emergency care, regardless of network status. Florida Blue will determine coverage and patient responsibility for emergency care based on the services provided.

A: As the only birthing center in Collier County and the only comprehensive stroke center in Southwest Florida, we understand that in-network access is crucial for all of our patients, and it’s especially concerning for those who need specialized care, close to home.

Conditions like pregnancy or chronic illnesses may be eligible for Continuity of Care, allowing you to continue seeing your current care team at in-network rates for a certain period even if NCH is out of network. Apply for Continuity of Care through Florida Blue. They will review and decide on applications on a case-by-case. Download the Continuity of Care form here. Call the number on your insurance card for questions about eligibility and out-of-network benefits.

A: For now, nothing has changed. Patients should continue scheduling and keeping appointments with NCH providers. If no agreement is reached by September 30, 2024, contact Florida Blue to verify out-of-network benefits before appointments scheduled on or after October 1, 2024.

A: To make your voice heard:

• Call Florida Blue at the number on the back of your insurance card. Tell them how important it is to keep NCH in network.
• Call your employer or broker.Let them know it’s important that you get the coverage you paid for and deserve, which includes having NCH in network.
• Post your concern on social media. Share your concerns on your social media and do the same on the FL Blue social media pages here @nchflorida.
• Consider your options. We are in-network with all major health plans in the area. If you have an upcoming renewal, choose a plan that keeps NCH in network. You can find a full list of the insurance plans we accept here.

A: Continue to visit www.StandWithNCH.com for ongoing updates and information on what you can do.

Please also be sure to read emails and letters from NCH. We’re committed to ensuring you have all the information you need to make the right decisions for your healthcare.