An oversight left those insured by Florida Blue and three other insurance companies out of network for emergency room visits to Mariners and Fishermen’s hospitals. Swift work, however, among several parties has resolved the issue for at least three of the insurance companies that Keys residents use that are now accepted in-network.
Last month, a Monroe County employee insured by Florida Blue visited the ER and noticed something wasn’t right about the charge. That’s when the employee went to Monroe County Employee Services Director Bryan Cook with concern that the ER visit wasn’t covered by Florida Blue, a Blue Cross Blue Shield product.
Come to find out, the hospitals’ new contracted ER services company, SHI Keys, didn’t have the same contract with the same in-network providers for insurance as Baptist Health South Florida, of which Mariners Hospital in Tavernier and Fishermen’s Hospital in Marathon are a part. Drew Grossman, CEO of Mariners and Fishermen’s hospitals, said its management care department got hold of SHI Keys president Ruddy Valdes. SHI then got connected with a Florida Blue rep and worked out the issue within two to three weeks.
SHI Keys, which is a group of emergency room physicians contracted to provide care at Mariners and Fishermen’s hospitals, started operating on Jan. 1, 2021. Grossman entered as CEO of Baptist’s Keys hospitals last February.
“Our requirement is all the plans (Baptist) has, you have to have. If we have Florida Blue, Aetna, Cigna and United Healthcare you have to have the same ones,” Grossman said. “He realized he didn’t have that.
“The whole thing was an oversight and I really don’t know where it was not caught. We really did an unbelievable job of how fast this thing got repaired,” he continued.
Agreements were also reached between SHI Keys and insurance companies Cigna and Aetna. Grossman said SHI Keys is still working on an agreement with United Healthcare.
“Sometimes it takes a little bit of time, but at least they’re in talks with them right now. We just have to wait for that one to get done,” Grossman said regarding securing an agreement with United Healthcare. “Nobody was out to harm. Nobody was out to do this maliciously. I apologize as CEO of Mariners and Fishermen’s, but also as a rep of Baptist Health, that this happened. We correctly got it fixed.”
Cook said a similar instance, some six years ago at Lower Keys Medical Center, took about six months to resolve. The fact that the issue at Baptist Health South Florida saw a resolution under four weeks speaks to the responsiveness from SHI and Baptist, as well as emphasis that the county placed on it, he said.
Roughly 1,300 Monroe County employees and 1,000 dependents are insured through Florida Blue. Not only does Monroe County Employee Services manage insurance for employees that fall under the board of county commissioners, but also constitutional offices that include the sheriff’s office, clerk of the court, supervisor of elections, property appraiser and tax collector.
While looking at it first on the employee side for Monroe County, Cook noticed that it was going to affect more than county employees, but also the entire community.
“We quickly said, ‘Oh gosh, there’s problem beyond our universe; this affects all residents,” Cook said. “All the right people came to the table and gave it the attention that it needed. Baptist had no intention of leaving any residents hanging like this.
“Obviously, had they stipulated to SHI Keys early on that they needed to take insurances prominent in the community, it would have obviously been much better. But they completely stepped up and put all the emphasis on it and resolved it,” he continued.
Patients of SHI Keys physicians in Monroe County will not pay more emergency services out-of-pocket costs than what’s indicated by their insurer. Additionally, per Florida law, emergency care is always delivered to any patient who requires it.
Cook said there tends to be confusion among people over why they still owe money after receiving care. He said insurance plans still have copays, deductibles and out-of-pocket maximums.
“It’s not that you wouldn’t owe anything, and it’s not that people should be offended that they should be paying something,” he said. “It’s the fact that they shouldn’t be paying more than their share.”
Patients who have questions about their bill from SHI Keys can call 386-516-5582 or Baptist’s Health Central Pricing Office at 786-662-7181 or by email at [email protected].