Michigan’s nationally renowned system of care for people hurt in car accidents is breaking down. Former and newly injured people are being denied care in the chaos unleashed by the state's new auto insurance law.
Care providers across the state say insurance companies are going far beyond what the law explicitly says they can do, and routinely delaying or denying payment for all kinds of post-accident care.
The situation is gravely jeopardizing the care, health and even lives of people like Dan Hawkins, who survived a catastrophic car crash in 1996. He’s paralyzed from the upper chest down.
"I can just sit in bed, but I need another human being to roll me, dress me, transfer me to a Hoyer lift, help me with food, drinking...." said Hawkins.
After the accident, Hawkins' insurance company, Farmers Insurance, paid for 24/7 home care. But the new auto insurance law lets insurers like Farmers cut payments for home care below the cost of providing the care, as of July 1.
John Beattie said in reality, it's even worse than that. He's director of Inspire Home Care, the company that provides Hawkins' home care aides.
In Hawkins' case, "we have not been paid one cent for services since July 1."
Beattie said the fee cuts in the new law will force him to stop providing care for all 38 of his company's severely injured auto accident survivors. But insurance companies are speeding that day up by paying nothing at all.
The message Hawkins says this send to him, and other people needing care? "You don't matter anymore."
Across Michigan, at least 700 injured people have already lost care, according to the Michigan Brain Injury Provider Council.
Like the ventilator-dependent patient who had to be dropped off at a local hospital because his home care agency closed, and he had nowhere else to go.
"You don't matter anymore."Dan Hawkins, survivor of 1996 accident, referring to the message sent to survivors by the new law. Hawkins is paralyzed from the upper chest down, and may lose his home care soon when his provider, Inspire Home Care, is forced to close.
A severely injured single mom whose children are trying to care for her when she lost her aides.
A severely injured three-year-old boy whose extended family now has to sign up for shifts to care for him.
Denise Sokolowski is Vice President of All About You Home Care. She said many insurance companies are going beyond what the new law explicitly allows, and slashing payments below cost for everything.
"Feeding tube supplies. That's their food that goes down their feeding tube. Gloves. Needles. Medications that are necessary," said Sokolowski.
Sokolowski said insurers are also playing what she calls "the shell game." Technically, they have 30 days to pay most bills, but if they send the bill back with a demand for more information, they can reset the clock another 30 days. It’s become a proxy for paying nothing at all.
"Billing is having to send in [bills] for the same week of services, over and over and over and over again," Sokolowski said. "We’re getting something back, and then you send it back, and then you get it back. 'You have to do it different.' And then there’s ones that you’re just not hearing anything from."
In Sokolowski’s experience, MEEMIC, a AAA company, is the worst offender. They’ve sent bills back up to 10 times, she says, and still, not a dime in payment.
"This isn’t just one or two insurance companies doing this. It really seems like it’s a coordinated effort, where they all said, come July 1, boom, it’s a wild, wild west out here. We’re given free rein to do what we want with these bills."Tom Judd, president of the Brain Injury Provider Council of Michigan
Meanwhile, the agencies still have to cover expenses like payroll for staff -- and many are exhausting whatever rainy day funds or loans they might have.
"This isn’t just one or two insurance companies doing this. It really seems like it’s a coordinated effort, where they all said, come July 1, boom, it’s a wild, wild west out here. We’re given free rein to do what we want with these bills," said Tom Judd, president of the Brain Injury Provider Council of Michigan.
Attorney Katie Tucker said it's far worse than most people realize. She specializes in auto accident cases. Tucker says she sees newly injured people being denied the most basic kinds of post-accident care. In one case, the insurance company refused to pay for surgery and physical therapy for a patient whose foot was badly injured in a car accident.
"The insurer said, we don't think the treatment's medically necessary."
Tucker said going forward, many Michiganders may need attorneys to force insurers to pay for care after an accident — if that care is even available. The home care industry for injured people is expected to virtually disappear by year’s end. There are also some doctors and other health care professionals who are starting to refuse auto accident patients.
We asked for recorded interviews with the insurance companies mentioned in this story, as well as the Insurance Alliance of Michigan, the trade association for all insurance companies, the Michigan Catastrophic Care Association, the insurance-run group that controls payments for large claims, and the Department of Insurance and Financial Services, the state agency that regulates the insurance industry.
No one agreed to the interviews.
DIFS provided this statement:
"The Michigan Insurance Code sets forth timelines for payment by insurers to service providers. The Michigan Department of Insurance and Financial Services is working with health care providers and insurers to facilitate resolution of questions and concerns related to billing under the new auto insurance fee schedule set forth in state law. DIFS encourages health care providers to first work with insurers to understand the new billing requirements, but we are available to assist providers and patients if a resolution cannot be reached expeditiously.
Patients can file a complaint on behalf of their providers at Michigan.gov/DIFScomplaints. Patients may also designate their health care provider as an authorized representative so that the provider may file a complaint on their behalf. Consumers and providers can call the Michigan Department of Insurance and Financial Services for more information at 877-999-6442 Monday through Friday from 8 a.m. to 5 p.m."
