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Criminal Justice & Legal System

Some insurance companies have stopped paying healthcare providers for auto accident survivors

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Tracy Samilton
/
Michigan Radio

Michigan's new auto insurance law allows insurance companies to slash payments for long term care providers for accident survivors by nearly half.

But some insurance companies are hastening the collapse of the care provider industry by paying nothing at all.
 
The 45% payment cut has already driven at least 42 providers out of business, according to the Michigan Brain Injury Provider Council, and experts say the law will likely force the majority of the remainder of the companies to close soon.
 
Around 18,000 accident survivors rely on the system of care that is being dismantled.
 

"We're reaching out and begging anybody right now to help us. Our goal is to try to keep Kelley alive," - Karen Howland, Kelley Miller's sister

Bob Mlynarek is a co-owner of First Call Home Healthcare. He said the 45% cut will likely force him to close altogether in October, leaving 45 patients with no care.

But he said his company will have to stop providing services for a quadriplegic patient, Kelley Miller, sooner, on September 14, because her insurance company, Auto-Owners, has paid nothing for her care since July 1.

Miller suffered a severe spinal cord injury in a car crash and depends on a ventilator and 24/7 nursing care to survive. Nurses must keep her ventilator operating at all times, make sure her trach is clear of phlegm, keep equipment sterile to avoid infections, perform bowel maintenance, and move her frequently to prevent pressure wounds.

That's in addition to home care aides who help her bathe, get dressed, eat, and drink.

Mlynarek said First Call has covered Miller's care out of its own finances, but can't keep it up any longer.

"And now we're in grave jeopardy of having to drop this patient with no place to go."

Miller said she is frightened her family might have to drop her off at the hospital on September 14. Her injuries make her vulnerable to life-threatening infections, including C. difficile and pneumonia.

Miller's sister, Karen Howland, said, "We're reaching out and begging anybody right now to help us. Our goal is to try to keep Kelley alive."

Auto-Owners insurance representatives did not return calls.

The Department of Insurance and Financial Services, which regulates the insurance industry, said in a statement:

The Michigan Insurance Code sets forth timelines for payment by insurers to service providers. We encourage providers to first attempt to resolve disputes directly with insurance companies, but if a resolution cannot be reached, the Michigan Department of Insurance and Financial Services can review.
Patients can file a complaint on behalf of their providers at Michigan.gov/DIFScomplaints. Patients may also designate their service 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.

Miller's situation is not unique. Dozens of patients and their families say their insurance companies have been delaying making any payments since July 1, when the 45% payment cut went into effect.

They say insurance adjusters don't return calls, or the insurance company makes multiple denials of claims for allegedly missing paperwork, even though the paperwork has been submitted multiple times. Or, they say, insurance representatives simply express a callous disregard for the well-being of their customers, sometimes claiming they have no choice but to enforce cuts that have put all the agencies in the customer's region out of business.

So far, there's no sign that Republican leaders in the state Legislature are planning to address the crisis by amending the law.

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