A South Florida family says their young daughter’s health is at risk as they find themselves caught in the middle of a contract dispute between their insurance provider and a local hospital.
Kelsey and Miles McGrane’s 4-year-old daughter, Parker, was born with an extremely rare genetic condition called mandibulofacial dysostosis with microcephaly (MFDM). The family says there are fewer than 200 cases that have been documented worldwide. The disorder affects bone development in the face and skull and can cause breathing problems, hearing loss, and developmental delays.
“Immediately upon being born, she was unable to breathe on her own, so she was intubated,” Kelsey McGrane recalled. Just 10 days later, she says Parker underwent her first surgery at Memorial Healthcare’s Joe DiMaggio Children’s Hospital to remove bone blocking her airway.
Since then, Parker has had 13 surgeries, including several on her skull. The McGranes say her care depends on a coordinated team of specialists at Joe DiMaggio.
“She’ll be monitored for the rest of her life, especially in the first 18 years when her body is consistently growing and changing,” Kelsey said.
But in September, the family learned their insurer, Florida Blue, failed to reach a new contract agreement with Memorial Healthcare System. That left the hospital out of network for Florida Blue members, affecting about 31,000 policyholders. The insurer has also been out of network with Broward Health since July, with no agreement reached, affecting 17,000 policyholders, according to a Florida Blue spokesperson.
For Parker’s parents, the news was devastating.
“It keeps me awake at night,” Kelsey said. “I truly don’t know what we will do.”
Her father, Miles, added, “Thinking about what could happen if an agreement is not reached — what it means for the ongoing care for my daughter — is very scary.”
In a statement to NBC6, Florida Blue spokesperson Jorge Martinez wrote:
“We’re disappointed that our valued relationships with these two safety net health systems remain unresolved, and we’re working tirelessly to find solutions that prioritize affordability for our members and the community. Unfortunately, the executives at Memorial Healthcare System and at Broward Health are demanding that we agree to significant rate increases that far exceed inflation which would unnecessarily burden individuals, families, and area businesses with much higher health care costs overnight.
We want to reassure our community that in the event of an emergency, ER services will continue to be covered, even at an out-of-network facility. Additionally, we are committed to ensuring continuity of care for our most vulnerable members, including pregnant women, children, and individuals undergoing active treatment for serious and complex health conditions, as well as those in post-operative care. These members may be eligible to continue receiving care from their current doctor or care team for a designated period.
We continue engaging in open dialogue with each of the health systems to reach sensible and sustainable new agreements and resolve this disruption as soon as possible. In today’s complex health care landscape and during these difficult financial times, our commitment to affordable care is more critical than ever. We remain focused on navigating these complexities, supporting our members, and ensuring they have access to care that is as affordable as possible.”
Doctors at Memorial Healthcare’s Joe DiMaggio say the dispute is already causing stress for patients and families.
“It’s creating a lot of anxiety among the families, the patients, and among the physicians as well,” said Dr. Holly Neville, chief of pediatric general surgery.
Neville said the not-for-profit hospital provides about $160 million in uncompensated care each year and needs reimbursement rates that reflect rising healthcare costs.
“We do need the insurance companies who are asking people to pay them, to provide them with healthcare insurance, to be able to reimburse hospitals for the care that they provide to their patients,” she said.
A spokesperson for Broward Health also issued a statement to NBC6:
“Broward Health has been working diligently to reach a new contract agreement with Blue Cross and Blue Shield of Florida, Inc., Health Options, Inc. and New Direction Behavioral Health, LLC (collectively and commonly known as Florida Blue). As the region’s level 1 trauma center and safety net hospital, we are doing everything we can to protect important care choice and access for our patients. Despite our strong desire to stay in Florida Blue’s network, we have been disappointed in their unwillingness to value the care Broward Health provides.
Our discussions with Florida Blue are about fairness; we are simply asking that Florida Blue reimburse our team at levels that are:
• Comparable to what they reimburse other health care providers in South Florida.
• Comparable to rates provided by other insurance companies for the same services.”
For now, the McGranes have secured a 90-day extension through Florida Blue’s continuity of care policy, allowing Parker to remain with her doctors. But they worry about what happens next.
“I just hope that in those negotiations, people can think of children like Parker who could be very negatively impacted if there isn’t a solution,” Kelsey said.
Her father echoed that sentiment.
“We were told initially there’s a chance she may never speak,” Miles said. “And we think in large part because of what Joe DiMaggio has done, she’s been able to grow into the little girl she is today.”
Negotiations between Florida Blue, Memorial Healthcare System, and Broward Health remain ongoing.
Other links:
https://www.browardhealth.org/patients-and-visitors/billing-and-insurance/accepted-insurance-plans/fl-blue
https://www.mhs.net/patients-and-visitors/insurance/floridablue
