It remains to be seen if a healthcare crisis in Indian River County can be averted.
After months of negotiation, Cleveland Clinic Florida and Florida Blue health insurance company are at a stalemate over the terms of an agreement that would keep Vero Beach’s only hospital in-network for Florida Blue members.
It is hard to believe the five-hospital system – soon to be six hospitals when Cleveland’s boutique West Palm hospital opens at CityPlace – would drop Florida Blue and its nearly 6 million members as potential customers. But a handful of other hospitals have already left the Florida Blue network, unwilling to accept the reimbursement rates and terms offered by the tight-fisted insurance company.
When Broward Health, one of the nation’s largest healthcare systems, exited Florida Blue’s network in July, the Miami Herald reported that, “Broward Health is accusing Florida Blue of underpaying it compared to other similar South Florida health providers and insurers. Florida Blue is accusing Broward Health of wanting too much money.”
Cleveland Clinic Indian River Hospital says the deadline to make a deal is only three weeks away.
But Florida Blue says in-network care will continue through the end of May.
Both sides confirm that, worst case, patients with certain conditions like cancer and heart failure who are in the midst of their care would not need to switch doctors or hospitals mid-stream.
This includes pregnant women scheduled to deliver babies in Cleveland Clinic Indian River’s newly renovated labor and delivery unit. Other patients can seek pre-authorizations for care to be covered in-network on a case-by-case basis.
Both Florida Blue and Cleveland Clinic said on Monday that Emergency Department services for actual emergencies are covered, even at out-of-network hospitals.
Florida Blue employer-provided plans, Florida Blue Marketplace plans and Florida Blue Medicare Advantage plans would be affected if the insurance company and Cleveland Clinic part ways.
“Patients can continue scheduling appointments as we work hard to reach a new agreement with Florida Blue,” said Dr. Richard Rothman, vice president and chief medical officer at Cleveland Clinic Indian River Hospital. “Our goal is to avoid disruptions to healthcare coverage and ensure continuity of care.
“I deeply understand the impact this situation could have on our patients and community, and our entire team is fully committed to finding the best solutions,” Rothman added. “As the leading provider of high-quality healthcare on the Treasure Coast, we remain dedicated to advocating for our patients and ensuring they receive the care they deserve.”
Cleveland Clinic is asking Florida Blue members who want to continue receiving care at Cleveland Clinic hospitals to let Florida Blue know.
Florida Blue’s communications office issued a statement last Monday in response to this paper’s questions.
“We continue to have regular discussions with the Cleveland Clinic Florida leadership team. Despite what Cleveland Clinic Florida has communicated, our contract ensures our members will maintain in-network access to Cleveland Clinic Florida doctors, hospitals, and health teams through at least May 31, 2026. We have worked together for decades, and Florida Blue remains committed to reaching an agreement that extends in-network access for our members beyond this date.”
The standoff apparently centers around Florida Blue’s reimbursement rates, as Cleveland Clinic Florida’s hospitals attempt to operate in the black in an increasingly competitive Florida market.
Since 70 percent of Cleveland Clinic Indian River’s patients are on Medicare, and another 12 percent are on Medicaid or uninsured, the hospital has zero control over what it can charge to provide care for 82 percent of its patients.
Contracts governing reimbursement rates for the remaining 18 percent of patients with private insurance like Florida Blue are one of the few factors impacting the hospital’s bottom line that are subject to negotiation.
“In today’s economy, where everyday expenses continue to rise, our goal is to balance support for our hospital partners with protecting our members from unsustainable cost increases,” Florida Blue said. “We’ve made reasonable offers to Cleveland Clinic Florida, aligned with inflation and local market conditions. We’re hoping to find a solution that works for everyone, especially the patients and communities we collectively serve.”
The nonprofit Cleveland Clinic Foundation, which operates Cleveland Clinic hospitals, might have a nationally recognized name and reputation, but its patient volume doesn’t give it the leverage of bigger players like HCA or Advent Health, which have dozens of hospitals scattered across Florida’s 67 counties.
In addition to its Vero Beach hospital, Cleveland Clinic Florida has hospitals in Tradition, Martin County north and Martin County south (technically operated as a single hospital), plus its headquarters hospital in Weston near Fort Lauderdale.
“If we cannot reach an agreement with Cleveland Clinic Florida before May 31, 2026, while we continue working to find a solution, some of our members may be eligible to continue receiving care for a period of time through Continuity of Care protections,” Florida Blue said.
The company also noted that Florida Blue members have access to “a robust network of hospitals, physicians, and ancillary providers in the Treasure Coast and in Palm Beach County for elective care.”
In the meantime, a Central Beach resident who just had a biopsy of a skin lesion and is awaiting diagnosis, worried that he may need to seek cancer care outside the Cleveland Clinic system, and a Vero Beach family with a complex medical history is fearful of losing access to trusted Cleveland Clinic physicians because they can’t afford to pay for out-of-network services on top of expensive Florida Blue premiums.
Another Vero resident just switched to Florida Blue from another insurance provider during the recent open enrollment period without knowing he may not be able to get treatment at Cleveland Clinic Indian River Hospital later this year.
Scenarios like these will multiply rapidly if Cleveland Clinic Florida and Florida Blue fail to reach an agreement.
