Survivors of traumatic car accidents and those who care for them received what some saw as a crushing blow on Friday, July 2.
As part of changes to Michigan’s auto insurance law, the most recent elements of which took effect Friday, there will be a new set of reimbursement schedules for medical services not yet covered by the federal Medicare law.
Some advocates for survivors of catastrophic car accidents, such as the family of 26-year-old Brandon Clark of Petoskey, say the law changes will drastically limit their access to the medical care they need.
The recent change cuts the amount that insurance companies must pay local providers for post-acute medical care for accident victims to just 55 percent of what they previously paid, as well as the number of hours family members can act as carers to 56 hours per day. week.
In 2019, the Republican-led Michigan legislature and Governor Gretchen Whitmer approved a review of Michigan’s faultless auto insurance system aimed at lowering the state’s high costs, and passed legislation with broad bipartisan support.
Part of the change involved giving drivers the ability to choose their preferred level of personal injury protection (PIP), which went into effect last summer — but another key part was setting up a reimbursement schedule for how much health care providers can afford insurance companies. billing when treating car-related injuries.
Clark’s mother, Lela Clark, said the recent changes have frustrated her, her family and thousands of other survivors of serious car accidents in Michigan.
“They’re taking away (physiotherapy), (occupational therapy), and there are people who can’t get doctor’s appointments because doctors say, ‘Sorry, we’re only getting 55% and we can’t do that,’” Lela said. “Operations too. These are things I’ve heard from other families, not just us.
“Brandon has surgery due next year,” Lela said. “We haven’t tried to schedule it yet because we don’t know what’s going to happen.”
On March 2, 1996, Brandon Clark was 18 months old when a reckless driver hit his vehicle head-on.
He was left paralyzed on a respirator and doctors at the time said he should have died on the spot according to all rights.
“It was a miracle that he is still with us,” said his mother.
Clark was airlifted to the University of Michigan Hospital in Ann Arbor, where he spent two months recovering. At the time, his father, Jared, and Lela were taken to a room with doctors and therapists and told that their son would never do more than move his eyes.
“We thanked them for their opinion and declared that we believe in God and miracles and walked out of the room,” Lela said. “Within that week, Brandon yelled ‘mom’ as we walked into his room.
“From that moment on, he hasn’t stopped talking.”
After being told that he would never eat, speak, move his arms, hands, legs, or even live another year alone, Brandon returned to his home in Petoskey and worked hard with therapy to the point that he eventually reached his goal. limited use of his arms and was able to move his legs slightly.
“Unfortunately, the therapists he had at home were unwilling to work with him all hour because of the difficulty of repaying them,” Lela said. “As a result, the therapist worked with Brandon for only 25 minutes of the scheduled hour, which resulted in less improvement.”
Lela said her family had private care in and out of their home for the first four or five years of his life, but due to a lack of staff and problems with their insurance company paying them in a reasonable amount of time, they started hiring their staff. own staff, who paid them out of their own pocket until a claims adjuster decided to reimburse.
“Eventually, his father (Jared) had to leave his career to… take care of Brandon because he had a hard time finding nursing staff,” Lela said. “Brandon needs someone awake to care for him day and night, 168 hours a week, 365 days a year. It’s impossible for Brandon to survive with the new limited care of just 56 hours a week.”
Lela said her son has a doctor’s prescription for skilled nursing or trained care for relatives, stating that he needs it at all times.
He needs all the care provided for him, including preparing meals, bathing, toileting, grooming, dressing, medicine, changing the trachea, maintaining a ventilator and countless other tasks.
“He often drops things due to lack of strength in his arms,” Lela said.
Year after year, at his clinic appointments, Lela and Jared Clark were told he wouldn’t make it another year, and they did a great job with him and “to continue what we were doing,” Lela said.
Now 26 years old, Brandon continues to live at home with his parents, who are trying to make his life as normal as possible.
“We go out to dinner, play ball, go to the movies and he has great friends who come home to visit him,” Lela said. “Unfortunately, he still can’t go to friends’ houses because they are unreachable. He misses a lot, but if he were forced into a nursing home, he would miss everything.”
“Brandon is 100% cognitive and understands what’s going on, although he doesn’t understand why his concern is being cleared.”
Lela said she has personally contacted 17 different private agencies and they have “understandably” refused to take in car survivors as of July 1.
“Brandon will be left unconcerned as of July 2, if some bills (Michigan Senate Bill No. 314, House Bill No. 4992 and House Bill No. 4486) are not passed to rectify the car reform bill of 2019,” Lela said.
Lela said that as a result, her family “sells literally everything we can, everything, our RV, Jared’s Trans-Am is for sale and my Jeep.
“We don’t know what’s going to happen,” Lela said. “We can’t let Brandon sit here, but no one is coming in.”
Recently, a number of bills have been filed with the Michigan legislature. One that has recently gone through the process is Senate Bill 28, which, as revised last week, would provide for the creation of a $25 million “post-acute car accident relief fund” within the Treasury Department.
The funds are intended to be distributed to health care providers in Michigan who can demonstrate financial losses as a result of the impending changes.
Anita Fox, director of Michigan’s Department of Insurance and Financial Services, said the auto innocence law was passed and designed based on concerns that Michigan had the highest auto insurance rates in the country, and many were uninsured.
“There were no parameters about how much a doctor or health care provider could charge,” Fox said. “If you have Medicare or have private insurance, there is usually an amount charged to your account and an amount that is contractually agreed to pay, which is another amount. No Debt, whatever that first number was. your car insurer paid.
“What has now been reduced is a cost control that the doctors and other healthcare providers can charge.”
Fox said car accident victims are still entitled to the exact same care, noting that the statute has not changed and they are entitled to everything they had in their contract when they were injured.
“But more importantly, the statute hasn’t changed, but the standard has,” Fox said. “They are entitled to what is needed for their recovery and rehabilitation. What you hear about the care is that some providers are saying that if we have to lower our rates in this way, we won’t be able to move forward, so you may lose access to care.
“That’s the big picture,” Fox said. “That’s where providers tell patients there may be a problem.”