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Despite making payments, Florida Blue customers denied coverage

NAPLES, Fla. Dianna Rosser thought paying off her monthly insurance premiums six months in advance would simplify things before her back surgery.

But for months, Rosser, a realtor, was turned away from doctor’s appointments during to being in a grace period from Florida Blue – for non-payment.

“I was about ready to cry,” she said.

More than 400 Florida Blue consumers have lodged complaints with the Florida Department of Financial Services against the health insurance giant between March 2016 and March 2017, a WINK News investigation has found.

In 42 out of Florida’s 67 counties, Florida Blue is the only option for insurance purchased through¬†the Affordable Care Act.

Complaints from 23 Southwest Florida customers were similar to Rosser – being denied coverage despite paying their monthly premiums.

Some complaints related to federal applied tax credits for Florida Blue plans. At least one customer was supposed to have her premiums completely covered by the applied tax credit, but Florida Blue denied paying her medical bills.

Click here for a list of complaints against Florida Blue

Rosser complained to the Florida Department of Financial Services, but said the agency did not seem to resolve her issue.

The department declined an interview request but said consumers are encouraged to file a coverage dispute complaint.

Florida Blue removed Rosser’s grace period following a WINK News inquiries, but is working to get past claims resolved.

The company also declined an interview request but provided the following statement:

“Open enrollment for the Affordable Care Act (ACA) is an extremely busy time of year with a large number of members making changes to their existing plans and signing up for new ones. This year, we experienced a record-high enrollment in ACA plans with approximately one million members enrolling for 2017 coverage. During the peak of open enrollment, a very small percentage of members experienced issues with their plans that were isolated, individual issues caused by the high volume. We take it very seriously when any of our members experience an issue. We implemented cross training, extended hours and added additional personnel to expedite our ability to address any issues and have seen a dramatic decrease in reported incidents.”

The Florida Department of Financial Services has notified the Florida Office of Insurance Regulation of complaints against Florida Blue.

The insurance regulatory agency can take action against a company for any law violations.

“The office is aware of the complaints with respect to Florida Blue, however, we cannot confirm or deny the existence of an investigation,” said Amy Bogner, the agency’s spokeswoman.

Southwest Florida residents considering health insurance through the Affordable Care Act Exchange can seek help and advice from groups such as the Health Planning Council of Southwest Florida.

Reporter:Lauren Sweeney
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