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Nemours No Longer To Accept Blue Cross Insurance

POSTED: Thursday, December 7, 2006

In just a few weeks, thousands of Northeast Florida families will be facing a health care crunch when the agreement between Jacksonville's Nemours Children's Clinic and Blue Cross-Blue Shield ends.

The two are expected to cut their ties on Jan. 1, leaving many patients unable to use their insurance coverage for the doctors and services they have relied for years.

Administrators at Nemours said they're terminating the deal because the reimbursement from the insurance giant is less than what it costs to provide patient care.

The result will be that patients who are covered by Blue Cross-Blue Shield will either have to find a new doctor or pay extra for care at Nemours.

A Clay County family told Channel 4 the split would hit its members hard. Sydney Desguin's daughter, Ally, will turn 2 years old the week before Christmas. However, before the girl's birthday, doctors will go in and fix the hole in her heart.

Ally has battled a heart condition since she was born. Surgeries have left her with a scar she calls her zipper, and she'll always have limitations.

"She brings so much happiness to so many hearts," Desguin said.

After her next surgery, Ally should be no different than most kids. The surgery could wait another six months, but on Oct. 30, her mom got a letter that set a new deadline.

"The contract will expire Jan. 1, 2007," Desguin said.

The contract between her insurer, Blue Cross-Blue Shield, and Nemours Children's Clinic, where the doctors work, helped save her daughter's life.

"I can't put a price tag on what those doctors should get paid. They gave my daughter life. I may have delivered her, but they gave her life," Desguin said.

After seven years of getting the same reimbursements from Blue Cross-Blue Shield for surgeries like Ally's, Jay Cummings from Nemours said costs have gone up. He said they've tried to negotiate doctor reimbursements with Blue Cross-Blue Shield but that the negotiations have gone nowhere.

"It doesn't mean we're going to subsidize insurance companies and use money that we're given," Cummings said.

Cummings pointed out that there are other options for patients like Ally and that she could continue to get care from Nemours and pay out-of-network costs.

"These (bills) are just the Nemours. I have two other stacks," said Desguin.

Ally's mother had tens of thousands of dollars in bills, all of which were reduced because Nemours and Blue Cross-Blue Shield have an agreement.

"Without insurance, there's no way. We would have to be paying medical bills for the rest of our life," said Desguin.
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