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Family fights insurance company to get chemo treatment covered

The Wares said insurance did cover some procedures, but things changed when it came to getting authorization for chemotherapy.

LAKE CITY, Fla. — Robert Ware and Deb Ware retired and moved from Lake City to Murphy, North Carolina but it is not the retirement they were planning. 

"My husband started having hip pain in April," she said.

Five months later, he was diagnosed with metastatic adenocarcinoma, a cancer. The retired nurse found security in the fact they had health insurance.

"They told me he was covered out of state," she said, "even here in North Carolina."

The Wares said insurance did cover some procedures, but things changed when it came to getting authorization for chemo therapy. 

"They keep refusing my husband to see Dr. Jennifer Jones," said Deb Ware.

Jones is an oncologist in Blue Ridge Georgia not too far from where they are living. 

"He was suppose to start his chemo treatment last Tuesday and he can't get it without authorization," she said.

Deb Ware said they have a Florida Blue Silver Plan, an HMO, purchased through the marketplace. She said it approved radiation treatment through another physician in Knoxville, Tennessee.

Most of the doctors have been by referrals. 

"We've jumped through more hoops than LeBron James has thrown basketballs," she said.

The family is at its wits' end she's made that loud and clear in her Facebook posts.

She said one person is telling them they are approved and another is telling them they are not.

"I'm just not sure at this point in time," said Deb Ware. "All I know is my husband needs his chemo therapy because his life depends on it."

If they drove back to the North Florida area, it would solve their problem almost immediately. But she said that is a 425 mile trek and, given her husband's health, is not practical .

"It has been a nightmare and my husband has been in tears, and he says, 'What did I do to make them hate me so bad that they don't want to help me?'" Deb Ware said.

Privacy laws (HIPPA) prevent Florida Blue from discussing the specifics of the case.

Is it an out of network issue? Is it a procedure that requires a primary physician referral?

On Your Side reached out to Florida Blue to get the Ware family the help they need. The health insurance company said it is reviewing what happened in this case and provided this statement: 

"Regarding the member issue you emailed us today:

Florida Blue is committed to caring for our members and ensuring they receive necessary care as appropriate and possible. When that doesn’t happen, we appreciate having it called to our attention and will work with members to address their situation."

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