JACKSONVILLE, Fla. — Patients with chronic illnesses are being forced to pay for their own care or not get the treatment they need.
Two medical giants are fighting over rates charged to patients for specialty services.
"I'd like to have a chance, too, before it gets worse," said patient Nancy Moore.
Moore was diagnosed with hepatitis C in 2009 but said she can't get the treatment she needs at the Borland-Groover Clinic because of a dispute over costs with her insurance company.
"They said they wouldn't OK it, then in the next paragraph said, 'We're not saying you don't need the medication,'" said Moore.
Moore and hundreds more patients are caught in the middle of a fight between Florida Blue and the Borland-Groover Clinic.
“They’re bullying us. That’s the bottom line,” said Dr. Kyle Etzkorn, with the Borland-Groover Clinic. He said Florida Blue asked for a 25 percent reduction in reimbursements rates for their procedures. “We cannot sustain our business with that magnitude,” said Etzkorn.
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In a statement, Florida Blue said, "Borland-Groover Clinic is one of the most expensive gastroenterologist groups in the state. Yet, the group asked Florida Blue for an increase in its rates over a three-year period. Florida Blue has tried to protect its members by proposing rates that bring Borland-Groover in line with the contracted rates of similar health care groups. Florida Blue has a responsibility to manage costs, not only for the health care system, but for its individual members. Florida Blue's network has plentiful coverage with other high-quality providers in the area to offer the same procedures for its members. In most cases, members can get an appointment within two to three days. Members are encouraged to call the Florida Blue number on the back of their card or visit www.floridablue.com for assistance in finding another gastroenterologist. We will continue to work on behalf of our members to control health care costs while providing high-quality care."
Etzkorn disagrees, saying they have the newest equipment for procedures. "We're looking at ways we can improve the outcome, but still decrease the cost," said Etzkorn.
Right now, there is a Facebook group and petition with nearly 5,000 signatures asking Florida Blue to negotiate with the clinic. Moore said she doesn't want to switch doctors, so instead she'll switch insurance companies.
“I’m just asking for something that’s going to save my life. Down the road, it could get a lot worse,” said Moore.
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