Broward County parents are reaching out to insurance regulators and Florida legislators, trying to force the state to intervene in the contract dispute between the public hospital systems and insurer Florida Blue.<\/p>\n
Kim Vasser, the Fort Lauderdale mother of an 8-year-old daughter with autism and a rare genetic syndrome, says her daughter has a team of specialists at Memorial Healthcare System. She believes Florida Blue plans now have an inadequate pediatric care network in Broward County \u2014 after a dispute last summer over the renewal of Florida Blue\u2019s contracts that put the county\u2019s two public health systems, \u00a0Broward Health<\/a> and Memorial Healthcare System<\/a>, out of network.<\/p>\n Vasser\u2019s daughter could no longer see her pediatric doctors and specialists.<\/p>\n She, as well as a half-dozen other parents, told the South Florida Sun Sentinel they have filed formal complaints with state agencies and written to legislators, urging them to intervene. A handful of emergency physicians who say they have had to transfer patients outside the county for admission told the Sun Sentinel they, too, have reached out to legislators to remedy this situation.<\/p>\n Florida Blue policyholders lost coverage at Broward Health on July 1 and at Memorial on Sept. 1. Both operate under the same CEO and much of the same executive team. About 60,000 Florida Blue\/Blue Cross Blue Shield policyholders are affected.<\/p>\n The two public health systems comprise 11 hospitals in Broward County and account for more than 98% of the county\u2019s pediatric hospital beds. They also represent the majority of pediatric specialists in the county and its pediatric trauma centers.\u00a0 Alone, Joe DiMaggio Children\u2019s Hospital<\/a>, operated by Memorial Healthcare System, offers about 50 types of pediatric specialists.<\/p>\n Florida law requires that insurance plans ensure adequate, timely access to in-network primary care and specialists, a provision known as network adequacy. Regulators can fine insurance carriers or force them to allow policyholders to allow members to see out-of-network doctors at in-network prices<\/p>\n \u201cThis is more than a contract dispute,\u201d Vasser wrote in her complaint to legislators. \u201cIt is a network adequacy failure that puts thousands of children at risk of delayed, denied, or unaffordable care.\u201d<\/p>\n At a standstill<\/p>\n At this time, negotiations between the insurer and the two health systems are stalled. No active negotiations are taking place.<\/p>\n The Florida Agency for Healthcare Administration<\/a>, which reviews network adequacy requirements, did not respond to multiple requests for comment about complaints or answer questions on whether it is pursuing network inadequacy complaints.<\/p>\n Vasser and other Broward parents say the situation with Florida Blue left them facing tough choices: pay out-of-network costs and take on crushing health care bills, or drive miles across county lines to find new specialists. Vasser switched carriers in January, but continues to fight for the other affected Broward County children.<\/p>\n Broward parent Mike O\u2019Hanlon, who is on a group Blue Cross Blue Shield plan, said his son needed an emergency appendectomy, which by law must be covered. However, while undergoing surgery, the family learned their son had a rotated bowel. \u201cWe want to go to the surgeon who\u2019s aware of his situation and who we are comfortable with, but because our plan is out of network, we can\u2019t, and we have to go down to Miami. It\u2019s frustrating,\u201d O\u2019Hanlon said.<\/p>\n Physicians told the Sun Sentinel they are suffering, too. Memorial and Broward Health doctors have had to turn away longtime patients and send children across county lines for follow-up care after treating them in the emergency department.<\/p>\n \u201cI am an emergency physician in Broward County at a hospital that does not have pediatrics other than seeing them in the emergency department,\u201d said a doctor who works for a private hospital in Broward County.\u00a0 \u201cPediatric patients who require admission need to be transferred, but if they have Blue Cross, there are no hospitals in Broward\u2026.so if the patients want to be kept in network, they have to be transferred out of the county. This is terrible for the patients and their families.\u201d<\/p>\n What\u2019s at stake<\/p>\n The multi-year contracts with Florida Blue for both health systems expired in 2025, and in signing new contracts, the public hospital systems are seeking reimbursement rate increases from Florida Blue and Blue Cross Blue Shield plans. The hospitals argue that Florida Blue\u2019s reimbursement offers don\u2019t cover the rising costs of specialized, high-quality care and don\u2019t represent a fair market increase.\u00a0 Florida Blue says the demands are \u201cexcessive\u201d and \u201cunreasonable\u201d and that agreeing to the increased rates would force them to spike premiums even higher for policyholders.<\/p>\n As of Friday, no one is at the negotiating table.<\/p>\n Through a spokeswoman, Memorial says it made concessions during negotiations in 2025 and offered this statement: \u201cIt is disheartening that Florida Blue has not issued a revised proposal to resume negotiations in the new year.\u201d<\/p>\n Memorial says it is still trying to get Florida Blue to pay more than $150 million in outstanding claims for care provided to its members over the past five years. Florida Blue did not directly respond to a question from the Sun Sentinel about Memorial\u2019s claim about the $150 million owed.<\/p>\n Broward Health gave the Sun Sentinel this statement: \u201cWe offered our last counter proposal to Florida Blue in January, at which time we were told they were having internal discussions regarding the proposal and we\u2019d hear from them shortly. We have had no communication with Florida Blue since, and no counter proposal was returned\u2026We ask that Florida Blue return to the table for the sake of our community.\u201d<\/p>\n Florida Blue offered this statement on Friday: \u201d Although we\u2019re disappointed that Memorial Healthcare System and Broward Health have chosen to remain out of network for an extended period, it\u2019s our duty as a mission-driven company to advocate for our members and the community, prioritizing their care and financial well-being. While we cannot speak to statements made by either system, we continue to have regular discussions with their leadership teams and welcome any opportunity to advance discussions towards a reasonable and sustainable resolution.\u201d<\/p>\n Offering some hope, Florida Blue added: \u201cWe\u2019ve made efforts to bridge the gap and resolve outstanding issues, and continue to emphasize that collaboration and compromise from both sides, prioritizing patients, will help us reach the finish line.\u201d<\/p>\n When asked about network inadequacy claims from parents, Florida Blue said as of March 1, specialized pediatric care provided by Nicklaus Children\u2019s Health System<\/a> doctors in Broward County, including those newly affiliated with Broward Health, will be considered in network. However, children who need inpatient admission will still need to be transferred out of the county.<\/p>\n Miami\u2019s Nicklaus Children\u2019s Hospital confirmed that its providers and facilities, including all of its inpatient and outpatient facilities in Broward County, are \u201cin network\u201d with Florida Blue. However, Nicklaus Children\u2019s Hospital does not participate in the Florida Blue \u201cBlue Select\u201d program and its primary care providers are not part of the \u201cMyBlue\u201d program.<\/p>\n An enrollment decline<\/p>\n Whether or not it\u2019s related to the Broward County situation, Florida Blue did lose enrollment in 2025.<\/p>\n Statewide enrollment in Florida Blue commercial plans dropped from 1.829 million in 2024 to 1.686 million in 2025. Enrollment in individual plans dropped from 482,000 to 419,000. Enrollment in group plans dropped from 468,000 to 451,000. And federal employees\u2019 plans dropped from 446,000 to 438,000. Medicare Advantage enrollment for Blue Cross dropped from 96,400 to 78,600, according to the\u00a0Florida Health Market Review 2026<\/a>.<\/p>\n The author of the market review, Allan Baumgarten, said most health insurers offering coverage in Florida saw improved enrollment in 2025, although the numbers varied by plan type.<\/p>\n In what could be considered a competitive move, Broward Health and Memorial Healthcare System, for the first time, jointly ventured into the volatile and potentially lucrative Affordable Care Act marketplace by launching their own insurer for Broward County residents in 2026. Their plan, 22 Health, has a competitive hook: access to physicians and specialists,\u00a0 including pediatric care, at the county\u2019s two largest public health systems. Enrollment for 2026 has closed. It\u2019s unclear how successful the plan is in its debut.<\/p>\n \u201cAt this time, we are not sharing enrollment numbers for 22 Health,\u201d said Communications Director Suzanne Tamargo.<\/p>\n Broward situation reflects national trend<\/p>\n Disputes<\/a> between hospitals and insurers over reimbursement rates and claim payments, like those in Broward County, are occurring nationwide. Jason Buxbaum<\/a>, a health policy researcher at Brown University School of Health, tracks them.<\/p>\n He said federal transparency laws are making it easier for hospitals and insurers to compare prices and reimbursement rates. That extra level of transparency can lead to more \u201caggressive negotiations.\u201d Patients get caught in the middle and both sides often urge those affected to pressure the other.<\/p>\n \u201cThese are real dollars at stake,\u201d Buxbaum said. \u201cThese are high-stakes negotiations that are economically significant.\u201d<\/p>\n Buxbaum said most disputes are resolved within a week, the rest within three months, making the situation in Broward County unusual. Meanwhile, all involved lose out: Hospitals suffer revenue losses, the insurer suffers enrollment losses, and patients lose access to health care choices.<\/p>\n At some point, as people complain to state regulators and legislators, Buxbaum said, someone may step in. It has happened in other states: \u201cThere is room for soft power or formal regulatory power to bring people together to get to an agreement. The state has a crucial role to play.\u201d<\/p>\n Vasser agrees. She said she does not place blame on the insurer or the hospitals: \u201cI just think at this point, a third party needs to come in and give assistance for a resolution to happen.\u201d<\/p>\n South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.<\/p>\n","protected":false},"excerpt":{"rendered":"Broward County parents are reaching out to insurance regulators and Florida legislators, trying to force the state to…\n","protected":false},"author":2,"featured_media":511693,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[8019,2808,84793,97,252,253,2558,3,5262],"class_list":["post-511692","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-broward-county","tag-florida","tag-florida-news","tag-health","tag-health-care","tag-healthcare","tag-latest-headlines","tag-news","tag-social"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/511692","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=511692"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/511692\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/511693"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=511692"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=511692"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=511692"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}