Florida's Congressional leaders calling for investigation into Florida Blue health care changes

WEST PALM BEACH, Fla. - "I'm a very active person," explained Deborah Nichols.

With each step, Nichols thinks about the long road to see a doctor.

"If I do not have my brace on it's very painful. It feels unstable," explained Nichols.

Five appointments, Nichols says were canceled. Some at the last minute.

"This is not right. I need help," explained Nichols.

Just months into the insurance year, Florida Blue is changing the doctors who take myBlue. A plan offered through the Health Insurance Marketplace or Affordable Care Act. Patients say the lists of doctors taking the plan online are wrong.

"There was a doctor in West Palm Beach they said would be my primary doctor now, and they worked at the Veteran's Hospital," explained Nichols.

"Are you a veteran?" Strathman asked.

"No, I am not a veteran. I couldn't believe it," said Nichols.

Doctors are also getting shut out.

"We were seeing patients up to that day, and then got notice that we were terminated," said Chrissi Whitehead of Better Me Healthcare.

Whitehead said their practice lost fifty patients. Patients she had to tell were no longer covered.

"We got a lot of angry people and upset people that all of a sudden didn't have a doctor anymore," Whitehead said.

Florida Blue is shrinking its network of doctors to keep costs low. Doctors got letters warning them of the change, but patients told us they never got a letter.

Next year, a new federal rule would require insurers warn patients 30 days in advance. That won't help those stuck this year.

"They just take hard-earned money, and they don't have to answer to anyone. I don't think it's fair," explained Whitehead.

Florida's Congressional leaders are reacting to the cries for help in our stories.

Congressman Deutch wrote, "It is unacceptable to stick consumers with bills for unexpected out-of-network care and force families to travel far from home in search of a new doctor because of false information in provider directories."

The congressman pointed out that insurers can be fined $100 per day per customer for this inaccurate information provided online.

"I will continue to press regulators to enforce directory accuracy rules so that consumers can be confident that the plan they select fits their health needs. When consumers pay their monthly premium they should have access to the care they are promised," Deutch's spokesperson wrote in a statement.

Senator Nelson sent a letter to the Centers for Medicare & Medicaid Services. "This is inexcusable. Consumers should be able to rely on the information provided to them when trying to decide which health plan best meets their needs," he wrote.

The list of doctors online must be updated at least monthly.

"I don't know frankly if monthly is enough," explained Mark Pafford.

Pafford is a state representative, and now works with Florida Chain. It's a group working to improve access to affordable healthcare.

"I think every week, every two weeks, is a lot better," Pafford explained. "Insurance companies the good ones should not be in the business of tricking people."

Florida Blue apologizes and regrets the issues which they say impact less than 10 percent of myBlue customers. Despite the changes, the insurer says its plan still meets standards.

It's been a substandard year for patents frustrated they're not getting the insurance coverage they paid for. If they make changes to their plan midway through the year, they'll lose their tax subsidy turning this so-called "affordable" care unaffordable.

"I'm paying $125 a month for nothing," explained Nichols.

Nichols finally went to see a knee specialist paying for the visit out of her pocket.

Florida Blue has said it will work with patients individually to make sure they are not facing extra out of pocket expenses due to the changes.

While this is a federal program, and you can complain to your congressman, the state can also help  mediate the issues. You can file a complaint with the Chief Financial Officer.

Florida CHAIN recommends you ask to see an out-of-network doctor at in-network prices. While there is no out-of-network portion of this health plan, some patients are seeing doctors who don't take the plan and working with Florida Blue to get reimbursed for their costs.

Florida Blue full statement
We apologize for, and truly regret, the challenges these members have experienced. We take this matter very seriously and are working aggressively to help those affected.
It is important to note that this situation impacts a small number of members in one of our new health plans who have encountered frustration and delay in care due to issues in finding in-network primary care physicians.This experience is not typical for most of our members.

We are committed to the health of those we serve throughout Florida, and we will personally work with any member to find a local, in-network provider and make an appointment to be seen.  
 
We invite members to call us, visit us online or meet face-to-face with an advisor at our Boynton Beach retail center or any one of our 20 other locations across the state.  

The network for this new plan has undergone some modifications since its introduction earlier this year.  Nonetheless, it continues to meet the required standards for access to local primary and specialist care.


Congressman Deutch full statement
It is unacceptable to stick consumers with bills for unexpected out-of-network care and force families to travel far from home in search of a new doctor because of false information in provider directories. As of January 1, 2016, the federal Centers for Medicare and Medicaid Services can fine insurers up to $100 per day for each beneficiary affected by out-of-date, inaccurate, or incomplete provider information. I will continue to press regulators to enforce directory accuracy rules so that consumers can be confident that the plan they select fits their health needs. When consumers pay their monthly premium they should have access to the care they are promised.
 

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