Florida Blue patients struggle to get care

Posted at 6:00 PM, Apr 25, 2016
and last updated 2016-04-25 18:00:55-04

Every stroke and every letter pressed onto every shirt has to be just right.

"You have to proof everything," explained Dan Peloff of All American Printing.

So it's hard to imagine, how a much bigger company never proofed the screens customers see when they log in to Florida Blue's myBlue health plan.

"This list is full of people not accepting "myBlue," explained Peloff, even though it says they are online.

"We had four appointments and four cancelations," explained Peloff.

It's inconvenient and costly.

"It has turned into a crisis," said Peloff. "I never felt so helpless trying to help someone in my life. I ran into a brick wall."

Peloff's wife battles mental illness and needs medication. Without a doctor to prescribe it, he finally took her to the Emergency Room.

"It's about $495 dollars more plus the inpatient place where she was. I still haven't got the bill for that, but it's going to be a lot. A lot," Peloff explained.

Florida Blue said it apologizes for the issues, and regrets these challenges impacting less than 10 percent of customers and turned down a request for an on camera interview.

"I think it was a misrepresentation of what they said it was," explained Peloff.

The CEO for the Medical Specialists of the Palm Beaches, Elizabeth Strombom, told us doctors are doing extra work to manage care. She said this plan also created a hardship for doctors who had to refer patients to specialists because the network of doctors taking the insurance is so limited. So a primary care doctor who had a relationship with a specialist for twenty years may no longer be able to refer patients to that specialist.

To see a specialist in this plan, you need to see a primary care doctor.

Boca Raton Regional Hospital said they were notified that they would no longer be part of the myBlue network as of July 1. "Florida Blue Cross has narrowed their primary care network for their Obamacare Exchange Health product," the hospital wrote. The Hospital directed customers with questions to Florida Blue.

Doctors are dropping like flies," explained Peloff.

But patients are stuck in the plan or they'll lose their tax subsidy which drastically reduces the cost of the plan.

"This is really effecting people. It's not just a mistake it has real life implications and it's maddening," said Peloff.

For a business man who makes his money making sure every detail is right.

Florida Blue said even though doctors are dropping out, the plan still meets federal guidelines. The insurer is  working with customers individually to address their problems, and make sure patients like Peloff don't face any "extra" out of pocket costs.

Florida Blue is also working to make sure the list of doctors online is updated.

The federal government requires that information be updated at least once a month.

Health and Human Services, which oversees the Affordable Care Act and Marketplace, told us starting in 2017 the insurance company will be required to provide 30 day written notice when a provider is discontinued from the plan. When a provider is terminated without cause, patients can continue to get treatment for in-network prices until treatment until its complete or for 90 days (whichever is shorter).

Florida Blue statement:
"We apologize for, and truly regret, the challenges these members have experienced.

It is important to note that we cannot discuss specific member situations due to privacy laws.  However, we have learned there are 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.

While this experience is not typical for most of our members, we take this matter very seriously and are working aggressively to help those who have been affected.

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.

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."  

Health and Human Services statement:
"While changes are typical between a health plan and their network, there are specific regulations and communication requirements to make sure enrollees have access to benefits. We work with states to make sure health plans are fully compliant with the rules and regulations."

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