When David meets Goliath: Why a local clinic wants to take on Florida’s largest health insurance company

Jennifer Voltz describes herself as someone who always fights for the underdog. In 2011, she opened FOCUS to provide speech, occupational, physical, and behavioral therapy to children with developmental disabilities.

“These kids need it. It is medically necessary. It is a service. It’s going to help them be able to communicate better be able to take care of themselves in the long run,” Voltz said.

But in the past several years, a large part of Voltz’s fight for the underdog has been about going to battle with a giant health insurance company.

Voltz explained she has persistent problems getting Florida Blue to process and pay claims for the children treated at FOCUS. As of publication, she said the company owed her around $30,000 in delayed claims.

The money is for care that is supposed to be a covered service in the family’s insurance plan.

“If they can’t give it covered by their insurance company, families can’t afford it,” Voltz said.

WINK News first exposed this problem in January when a boy with Down syndrome was in jeopardy of losing access to his therapy because Florida Blue had not paid about a year’s worth of bills. After our investigation, the company wired the full payment to FOCUS so that he could continue his care.

But months later, Voltz said the problem started again, and it wasn’t just one client. She said she has dozens of children hanging in the balance now. It puts her in an impossible situation as a business owner because she cannot treat the children for free, but she does not want to turn the families away.

“It’s really frustrating. It’s really difficult. I have families in my office here crying,” she added.

So, she’s decided to fight back. She hired an attorney to take Florida Blue to court to end the problem once and for all.

“I like to fight for the Davids in these David and Goliath fights,” said Attorney Robert Goodman, who is representing Voltz.

Goodman, a Fort Myers personal injury and civil liability attorney, said he feels insurance companies engage in the behavior because people seldom fight back when an insurance claim is not paid on time or denied.

“People are missing out on treatments, and some of these treatments are important to their health and well-being. They’re just walking away from it because it’s too difficult,” he said.

But a spokesperson for Florida Blue said less than 0.001% of claims processed by the company result in a complaint.

WINK News obtained data from the Florida Department of Financial Services that showed 852 complaints against the company for delaying, denying, and underpaying claims between January 2018 and July 2020. Of those, the state reported only 158 as settled or resolved.

LINK: How to File a complaint against your insurance company

“Florida Blue processes 75 million claims each year for services and supplies provided to our members. We understand the importance of each of those claims as they directly impact not only the health of our members but also the financial stability of our health care provider community,” said Christie Hyde DeNave, a spokesperson for Florida Blue, in an email.

DeNave said after WINK News alerted her of the issue, Florida Blue was able to “expedite” the claims due to FOCUS. As of the time of publication, Voltz said she had not received the monies owed.

According to Florida Blue, the issue with the claims processing at FOCUS had to do with a staffing change. Voltz also disputed that explanation. She said she’s been getting a host of reasons for why claims are not being processed in a timely fashion.

At this point, she said she is hesitant to take on any new patients who have Florida Blue insurance.

“It is evident that it’s something they’re doing on purpose in a way not to have to pay. They’re hoping that we just won’t fight them, that we don’t have the power because they’re such a big entity.”