A South Florida family says they were pushed into a difficult, last-minute healthcare decision as their insurance provider, Florida Blue, remains unable to reach agreements with two of the region’s largest public hospital systems — and is now in negotiations with a third.

NBC6 first reported in September the impact the ongoing contract dispute was having on 4-year-old Parker McGrane, who receives specialized medical care at Memorial Healthcare’s Joe DiMaggio Children’s Hospital. That hospital system became out-of-network on Sept. 1.

Parker has mandibulofacial dysostosis with microcephaly, a rare condition.

“There’s less than 200 documented cases in the world,” according to her mother, Kelsey McGrane. 

Since birth, she has relied on a team of specialists at Joe DiMaggio to monitor and treat her condition.

“I mean, it keeps me awake at night. I don’t truly know what we will do,” Kelsey said in an interview earlier this fall as the family waited for a resolution.

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. NBC6’s Amy Viteri reports

Both Memorial Healthcare and Broward Health — the county’s two public hospital systems — are currently out-of-network for Florida Blue policyholders. This week, the insurer confirmed it is also negotiating a new contract with the Cleveland Clinic. The hospital system told NBC6 that if no agreement is reached, it could become out of network for Florida Blue members early next year. 

Florida State Rep. Chip LaMarca, whose own family is insured by Florida Blue, said constituents across the district are facing similar uncertainty.

“I’m extremely frustrated, extremely disappointed,” LaMarca said. “If they don’t come back to the table, we have a legislative session starting. I’d be more than willing to have this conversation in Tallahassee to make sure they did.”

LaMarca believes a major sticking point in negotiations is what he describes as a wide variation in reimbursement rates the insurer pays different hospital systems.

“I’m a very free-market person, but I have to disagree when one system is somewhere in the area of 30 or 40% higher reimbursement rates,” he said. “A fair reimbursement rate should really be fair market value.”

In a statement, a Florida Blue spokesperson wrote: “Across the health care industry, rates between insurers and providers consider local factors like hospital size, scope of services provided, patient population, health outcomes, and patient experience. As a mission-driven health insurance company, we have a duty to advocate for high-quality care that is as affordable as possible — by negotiating fair rates that balance member needs with the financial pressures faced by hospital systems and everyone in the health care industry.”

Parker’s father, Miles McGrane, told NBC6 the uncertainty about whether an agreement would ever be reached weighed heavily on the family.

“It’s very scary to think about what eventually could happen if an agreement is not reached — what it means for the ongoing care for my daughter,” he previously said.

Although the family received a 90-day extension allowing temporary continued access to Joe DiMaggio due to Parker’s condition, they said they ultimately couldn’t wait any longer. Faced with the open enrollment deadline and no sign of a breakthrough, they made a difficult decision.

The family wrote this to NBC6: “Due to the fact that an agreement has not been reached between Florida Blue and Memorial, we were forced to find a new insurance provider. As a family, we are disheartened. We are grateful to have a new plan that allows us to continue seeing Parker’s team of doctors at Joe DiMaggio, but we also know there will be limitations on her care because of the type of plan we had to switch to.”

LaMarca said he hopes all parties will agree to a deal that reimburses hospital systems more equitably — but said lawmakers could step in if necessary.

“Either they do something to make it more fair or, you know, the state of Florida may find another carrier,” he said.

Memorial Healthcare has previously said it is seeking rates that allow the system to cover its costs. Broward Health has said it is seeking reimbursements comparable to those paid to other hospitals.

When asked about the status of negotiations, a spokesperson for Florida Blue told NBC6, “We are making significant progress with the leadership teams from Broward Health and Memorial Healthcare System. We understand the concern and frustration that our members and the community feel given these two trusted local health systems are currently out of network. Resolving this is our highest priority, and we look forward to sharing the good news once agreements are finalized.”

As for the ongoing talks with Cleveland Clinic, the timelines differ: Florida Blue says the current contract guarantees member access through at least May of next year, while Cleveland Clinic maintains the current agreement could put the hospital out of network as soon as March. If that were to happen, more than 150,000 Florida Blue policyholders with employer-sponsored, Health Insurance Marketplace and Medicare Advantage plans would be affected, according to a spokesperson for Cleveland Clinic Florida. Both sides say they are hopeful an agreement will be reached before then.