Auto crash survivors, advocates concerned over insurance law change
Survivors of traumatic auto crashes as well as those individuals who care for them were dealt what some saw as a crushing blow on Friday, July 2.
As part of changes in Michigan auto insurance law, the most recent elements of which which went into effect on Friday, there will be a new set of fee schedules for medical services that aren’t already covered under federal Medicare law.
Some advocates for catastrophic auto crash survivors, such as the family of 26-year old Brandon Clark of Petoskey, say the changes to the law will drastically limit their access to medical care they need.
The recent change shrinks the amount insurance companies will have to reimburse local care providers for post-acute medical care for crash victims to just 55 percent of what they previously paid, and also caps the number of hours that family members can act as caregivers to 56 hours a week (only for those services that do not have a Medicare code. Services provided that have a Medicare code will be reimbursed at 200% of the amount payable under Medicare).
In 2019, the Republican-led Michigan Legislature and Gov. Gretchen Whitmer agreed to an overhaul of Michigan’s no-fault auto insurance system, aimed at lowering the state’s high costs, and approved legislation with wide bipartisan support.
Part of the change involved giving drivers the option to choose their desired level of personal injury protection (PIP) coverage, which took effect last summer — but another big piece was setting up a fee schedule for how much health providers can bill insurance companies when treating auto-related injuries.
Clark’s mother, Lela Clark, said the recent changes have been frustrating to her, her family and thousands of other Michigan survivors of severe auto accidents.
“They are taking away (physical therapy), (occupational therapy), and there’s people who can’t get doctor’s appointments because doctors are saying ‘Sorry, we’re only getting 55% and we can’t do that,'” Lela said. “Surgeries as well. These are things I’ve heard happen from other families, not just us.
“Brandon has a surgery that supposed to be coming up in the next year,” Lela said. “We haven’t tried scheduling it yet, because we don’t know what will happen.”
On March 2, 1996, Brandon Clark was 18 months old when a reckless driver hit the vehicle he was riding in head-on.
He was left a quadriplegic on a ventilator and doctors at the time said by all rights he should have died on the scene.
“It was a miracle he is still with us,” his mother said.
Clark was air lifted to the University of Michigan hospital in Ann Arbor, where he spent two months recovering. During that time his father, Jared, and Lela were brought into a room with doctors and therapists, and were informed their son would never do more than move his eyes again.
“We thanked them for their opinion, and stated that we believe in God and miracles and walked out of the room,” Lela said. “Within that week Brandon yelled ‘momma’ as we walked into his room.
“From then on, he hasn’t stopped talking.”
After being told he would never eat on his own, speak, move his arms, hands, legs or even live another year, Brandon returned to his Petoskey home and worked hard with therapy to the point he eventually regained limited use of his arms and could slightly move his legs.
“Unfortunately, the therapists he had at home were not willing to work with him the entire hour they were scheduled, due to difficulty in reimbursing them,” Lela said. “Because of this, the therapist only worked with Brandon 25 minutes of the scheduled hour, leading to 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 because of a lack of staff and problems with their insurance provider paying them in a reasonable amount of time, they began hiring their own staff, paying them out of their own pocket until an adjuster decided to provide reimbursement.
“Eventually his father (Jared) ended up having to leave his career to … care for Brandon, due to difficulty finding nursing staff,” Lela said. “Brandon needs someone to be awake to care for him all night and day, 168 hours a week, 365 days a year. It is no possible for Brandon to survive on the new limited care of only 56 hours a week.”
Lela said her son has a doctor’s order for skilled nursing or trained family member care, stating he requires it at all times.
He needs all care provided for him including meal prep, bathing, toileting, grooming, dressing, medicine, changing of trachea, maintaining a ventilator and countless other tasks.
“He drops things often due to lack of strength in his arms,” Lela said.
Year after year, Lela and Jared Clark were told at his clinic appointments he would not make it another year, and they were doing 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 attempt to make his life as normal as possible.
“We go out to dinner, ball games, to the movies and he has great friends that come see him at his home, “Lela said. “Unfortunately, he still is unable to go to friends home due to them being inaccessible. He misses out on a lot, but if he was forced into a nursing home, he would miss out on everything.
“Brandon is 100% cognitive and understands what is going on, although cannot understand why his care is being ripped away.”
Lela said she has personally reached out to 17 different private-duty agencies and they have “understandably” refused to take auto survivors as of July 1.
“Brandon will be left with no care 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 auto reform law of 2019,” Lela said.
Lela said as a result her family is “literally selling everything we can, everything, our motor home, Jared’s Trans-Am is up for sale and my Jeep.
“We don’t know what’s going to happen,” Lela said. “We can’t just leave Brandon sitting here, but nobody will come in.”
A number of bills have been introduced into the Michigan Legislature recently. One which recently has been moving through the process is Senate Bill 28, which as revised last week would provide for the creation of a $25 million “post-acute auto injury provider relief fund” within the state Department of Treasury.
The funds are meant to be dispersed to Michigan care providers who can prove financial losses due to the impending changes.
Anita Fox, director of Michigan’s Department of Insurance and Financial Services, said the auto no-fault law was passed and designed based on concerns that Michigan had the highest auto insurance rates in the country, and many were going uninsured.
“There were no parameters on how much a doctor or provider could charge,” Fox said. “Usually when you have Medicare or have private insurance there’s an amount that’s charged to your bill and an amount that’s contractually agreed to pay, which is a different amount. Under no-fault, whatever that first number was was your auto insurer was paying.
“Now, what’s reduced is a cost control what the doctors and providers other others can charge.”
Fox said auto accident victims are still entitled to the exact same care, noting the statute didn’t change, and they are entitled to whatever they had in their contract when they were injured.
“But more importantly, the statute didn’t change the standard of care that they’re entitled to,” Fox said. “They are entitled to what is needed for their recovery and rehabilitation. What you’re hearing about the concern is some providers are saying if we have to reduce our fees like this, we’ll not be able to continue in business, therefore you may lose access to care.
“That’s the big picture of it,” Fox said. “That’s where providers are saying to patients there could be an issue.”
The Michigan Department of Insurance and Financial Services also noted the 56-hour provision for family provided care is not a cap. An injured person is still entitled to the attendant care that is medically appropriate. For those who need more than 56 hours of attendant care per week, insurers must continue to cover that care, but may choose to either use an outside care provider or they may choose to contract with the family to provide that additional care.
A majority of auto insurance companies, over 90% of the market, have indicated they will consider on a case-by-base basis contracting with family members of family associates to pay benefits for attendant care over this hourly limitation as needed, the department said.
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