One of Florida’s largest health insurers is facing complaints about confusing claim denials and disappearing doctors in 2016, leading some consumers to protest they did not get what they bargained for in Florida Blue’s Obamacare coverage.
The company, also known as Blue Cross & Blue Shield of Florida, has apologized and insists it is working hard on problems that have surfaced in Palm Beach County in particular.
But that does not wipe away a basic problem with fairness in how the marketplace should operate, as customers like Jeff Gordon of Boynton Beach see it.
“It’s a classic bait and switch,” Gordon said.
Doctors he relied on as being part of the myBlue gold plan when he signed up on healthcare.gov suddenly were gone a few months into 2016, he said. He and his wife were left largely with unfamiliar clinics dozens of miles away, as he tells it.
But now it’s too late to switch plans and keep the federal subsidy that helps reduce premiums under the Affordable Care Act, he said.
“I’m stuck with them,” he said. “It’s not fair.”
Other complaints have sounded similar themes: “When you finally come to the doctor in 2016, you discovered that doctor that was in network upon your signing to the plan actually is not included,” said “consumeraffairs.com.on
Privately, an official at one regional doctor group said it was puzzled by claim denials from Florida Blue early in 2016 and heard little concern from the insurer when the doctors warned they might be forced to leave the plan — and soon did so.
The problems come after a series of developments including a GOP-led Congress’s blocking of billions of dollars in “risk corridor” funding designed to help health insurers cushion losses in exchange plans.
UnitedHealthcare, the biggest health insurer in the country, said last month that it plans to exit most Affordable Care Act exchanges by 2017.
So the question arises: Is Florida Blue taking steps to make its own plan unattractive because it fears it is too financially risky?
“No, that is not the case at all,” said Florida Blue spokesman Paul Kluding. “Since the launch of the Affordable Care Act’s marketplace, Florida Blue has offered plans in every county in the state of Florida, and we remain committed to providing health care to all Floridians through the marketplace.”
This issue is “limited to one, new marketplace product, which is designed to provide access to affordable health care to more Floridians,” Kluding said. “This product is focused on improving health outcomes, and therefore, requires greater engagement and collaboration among the patient, the doctor, and Florida Blue. This need for greater engagement has resulted in some modifications to the doctors available in this network, including some who have chosen to no longer participate in this product.”
Florida Blue is not trying to back out of exchange coverage, he said.
“Given the fluctuation of insurers’ participation in the marketplace, there is a significant chance Florida Blue will be the only statewide plan in 2017,” Kluding said. “Unlike other insurers that select only certain counties, we are dedicated to improving the health of all Florida communities while adhering to our mission of helping people and communities achieve better health.”
As for problems in places like Palm Beach County, Kluding said, “We apologize for, and truly regret, any challenges our members have experienced. This year in certain markets, we introduced a new localized health care product, named myBlue, aimed at providing more Floridians access to affordable care.”
He continued, “We have learned of some issues in Palm Beach County related to selecting a primary care doctor. Due to recent changes in the network, some of the myBlue members in Palm Beach County were assigned new primary care doctors, and a small percentage of those have had delays getting appointments. We are actively assisting members with finding convenient primary care doctors and helping them get appointments.”
In Boynton Beach, Gordon said Florida Blue assigned a caseworker he credits with “diligently helping” the family find better options for doctors close to them.
The Florida Office of Insurance Regulation said it is checking on the problem.
“The Office will be speaking with Florida Blue to discuss this issue,” spokeswoman Amy Bogner said.
Florida Blue says it leads the state in total customers with more than 4 million. The merged companies of Aetna and Humana appear on track to collect the most annual premium dollars in the state.
Florida Blue leads in total complaints about health insurers to the state’s Department of Financial Services since Jan. 1, 2015, according to information requested by The Palm Beach Post. Complaint numbers below are for all products and services, not just Affordable Care Act exchange plans.
“We take member concerns very seriously,” Kluding said. “As the leading insurer in the state, Florida Blue has more than 4 million members in Florida, and the number of issues reported should be considered in the context of our large membership base.”
Complaints since Jan. 1, 2015
Florida Blue 1552
UnitedHealthcare of Fla. 682
Humana Medical Plan 466
Coventry Health Care 417
Health Options Inc. 324
Source: Florida Department of Financial Services