First Physicians Group specialists and Sarasota Memorial remain in-network with Florida Blue Medicare Advantage
Sarasota Memorial Hospital starts a year-long centennial celebration
Sarasota Memorial Hospital first opened Nov. 2, 1925; a year-long centennial celebration began Jan. 6, 2025.
- First Physicians Group primary care doctors will be out-of-network for Florida Blue Medicare Advantage plans starting July 1, 2025.
- Approximately 3,800 patients are affected by this change, but specialists and Sarasota Memorial Hospital remain in-network.
- Florida Blue stated the change ensures their network meets member needs, while First Physicians Group cited industry changes as the reason.
- Affected patients can explore options like switching Medicare Advantage plans or returning to Original Medicare during open enrollment.
- Patients with ongoing serious conditions may qualify for continued in-network care through a “continuity of care” authorization.
Primary care doctors in First Physicians Group, a multi-specialty medical group affiliated with Sarasota Memorial Health Care System, will no longer be considered in-network for patients with Florida Blue Medicare Advantage plans, effective July 1.
The decision only impacts primary care physicians and not specialists.
About 3,800 patients may be impacted, Sarasota Memorial Hospital spokeswoman Kim Savage said in an email response to a query from the Herald-Tribune.
Savage added that First Physicians Group will mail letters during the first week in June to the people who have seen an FPG primary care physician in the past three years who were covered by a Florida Blue Medicare Advantage plan, as well as Medicare Advantage plans from out-of-state Blue Cross and Blue Shield coverage providers.
“The change in network by Florida Blue/BCBS applies only to FPG primary care physicians and only to Medicare Advantage patients,” Savage wrote. “Medicare Advantage patients with Florida Blue or other BCBS plans can continue to see other providers in First Physicians Group for specialty care and services.
“Both Sarasota Memorial Hospital campuses and its full continuum of outpatient services and urgent care centers also remain in the Florida Blue/BCBS network.”
A statement already posted on the First Physicians Group website is at https://bit.ly/4mHGRl9.
Florida Blue spokeswoman Estella Gray wrote that Florida Blue Medicare made the change to ensure that its network of providers meets members’ needs.
“As part of this effort, we regularly review the network to identify needed changes and ensure we have the right mix of primary care high-quality, local providers focused on supporting the well-being of our Medicare Advantage members,” Gray wrote.
She said the hospital and the insurer “mutually agreed to remove First Physicians Group’s primary care physicians from the Florida Blue Medicare Advantage HMO and Florida Blue Medicare Advantage PPO networks effective July 1, 2025.”
Patient raises concerns after learning about the change
Longboat Key resident Holly Barrett emailed the Herald-Tribune Friday, after she learned about the split Thursday while visiting her primary care physician at First Physician’s Group.
“I was told this news was only received by them recently and the practice is very concerned about the impact,” Barrett wrote. “Primary care physicians are in short supply in most areas of our country. We are fortunate to have in Sarasota a strong healthcare system.”
Barrett went on to say that the lack of access to primary care physicians will impact patients by exacerbating a physician shortage, which is evident even in the off-season; limiting access to the widest range of hospital services in the area; and disrupting continuity of care.
“When one has chosen a PCP who is located in or near the hospital they are also having great access to all of their needs that they might have whether it be surgery, physical therapy, or so many other services,” Barrett wrote. “The primary care physicians also know the specialists … It should be obvious that if a primary care physician and a specialty physician are in the same network that their communication back-and-forth is almost immediate and far superior to those that have no connection.”
She also cited concerns about the level of communication between the specialists she must see and whomever she will use as a primary care physician in the future.
Why is this change being made?
Insurance companies and medical providers enter contracts for in-network coverage reimbursement rates, as well as scope of services that are covered by an insurance provider.
For example, in 2021, SMH and Florida Blue conducted extensive talks that also extended to coverage of services at the Venice campus, as well as services at SMH’s Radiation Oncology Center on University Parkway.
When the two sides can’t agree, all or part of the medical services offered may be ruled as out-of-network by a provider.
For example, SMH parted ways with Humana at the end of March 2019 but all First Physicians Group providers remained remained in-network until Dec. 31, 2024.
Gray did not explain why only the primary care providers at First Physicians Group are being removed from its network of care.
Savage wrote: “We were informed that the change is part of Florida Blue’s plans to adjust their primary care network due to changes in the Medicare Advantage industry.”
Earlier this year GuideWell Health, the parent company of Florida Blue and Keralty – a multinational company based in Spain that offers both health insurance and medical care in countries around the world – partnered to open six Sanitas Medical Centers in Southwest Florida – including one each in Venice and North Port. The centers offer adult and pediatric primary care options that officials say are designed to reduce healthcare costs and and provide a more holistic approach.
Has Florida Blue done this elsewhere?
This is not the first time Florida Blue has removed primary care physicians in-network coverage but continued to cover specialty care. For example, in Lee County, primary care physicians in Lee Physician Group, which is affiliated with Lee Health, were deemed out of network for Florida Blue Medicare Advantage plans in September 2024, according to a published report by Fort Myers-based NBC2 news.
WINK news reported that Florida Blue removed primary care physicians at NCH Health Group, the medical group affiliated with the Naples Community Hospital healthcare system, from in network coverage.
Last October Florida Blue performed the same service split for primary care physicians affiliated with Baptist Health hospitals for Medicare Advantage and myBlue Health HMO plans, according to the Florida Times-Union.
Does this change affect other Sarasota hospitals?
Sarasota County’s other two hospitals – HCA Florida Sarasota Doctors Hospital and HCA Florida Englewood Hospital – are both owned by Hospital Corporation of America, which typically negotiates its insurance coverage on a national basis.
Doctors Hospital spokeswoman Monica Yadav said by email that HCA Florida Healthcare hospitals are in-network participants in the Florida Blue Medicare Advantage Plans.
What are the options for patients affected by the change?
Savage noted that Florida Blue Medicare Advantage patients who want to remain with their existing primary care physicians should call the number on their insurance card to understand their options for primary care for the remainder of 2025.
The next Medicare Open Enrollment period is Oct. 15 through Dec. 7, 2025.
At that time patients can find a new Medicare Advantage plan that lists their primary care physician in-network.
That list is available online at https://www.firstphysiciansgroup.com/insurance or by calling the group’s central office number at 941-917-2600.
Another option is to switch to an original Medicare plan. That can be done during the Oct. 15-Dec. 7 window or during the Medicare Advantage Open Enrollment period, which runs form Jan. 1 to March 31 every year.
Questions about enrollment changes can be asked by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
At that number, it is also possible to ask Medicare for a special enrollment period, which is often approved when there are significant changes to an insurance provider’s coverage network.
Savage also noted that patients undergoing treatment for a serious or complex chronic condition should call the number on their card to see if they qualify for continuing in-network care for their primary care physician through a ‘continuity of care” authorization from Florida Blue and other Blue Cross Blue Shield Medicare Advantage providers.
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.