Victims of a Michigan car accident could lose care under new rules

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LANSING, me. – Courtnie Bush, 16, was never supposed to wake up, let alone smile, stand and walk again after being in a car accident in December.

Her mother Jenna said what Courtnie has accomplished since then is nothing short of a miracle, and she credits therapists and home nurses.

“She woke up swinging, I mean, she woke up, she gave a thumbs up, and she has made progress since then,” Bush said.

READ: Michigan drivers face a new insurance choice

Despite a traumatic brain injury, Courtnie took steps to return to her passions: baking desserts, singing in choir, playing soccer and basketball, and graduating from high school with her twin brother. But she and her family are concerned that a change in Michigan’s no-fault auto insurance law will cause them to lose care and momentum as they recover.

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Some companies that provide rehabilitation services to people like Courtnie are alerting families from July 1. You will no longer provide certain services because insurance company reimbursements for services not covered by Medicare have been reduced by 45%.

In 2019, lawmakers responded to Michigan’s highest national premiums for auto insurance by passing laws allowing drivers to choose their level of personal injury protection, replacing the state requirement that drivers must purchase unlimited lifetime coverage. The overhaul also reduced reimbursements for health care providers treating accident victims and can charge auto insurers much more for the same services than is paid for by employer plans or state insurance.

CONTINUE READING: The auto insurance fee for health insurance in Michigan will decrease

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Bush said she felt lucky that last July, when drivers in Michigan had a choice of what personal injury protection to buy, she continued to pay for the unlimited coverage.

“When things changed, I knew I shouldn’t change,” Bush said. “I knew the coverage we wanted to keep and it wasn’t a risk we wanted to take.”

To avoid closing the doors, the Ingham County’s Origami Brain Injury Rehabilitation Center is limiting its entry requirements to those with less catastrophic injuries, said the centre’s CEO and President Tammy Hannah.

“This is the part that keeps me up at night because we serve multiple residents who are quite disastrously injured, we are successful, we are their family, they were injured a few years ago, we are their long-term home,” said Hannah. ” Origami won’t be able to work the way we do today for more than another year. “

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Under the new fee schedule, services covered by Medicare will have a reimbursement rate of 200%, while more specialized services like home care without a Medicare code will be reimbursed at 55% early in 2019.

Proponents said the fee schedule came about because providers could charge insurers unnecessarily high fees, which would overload the system. But Hannah said origami operates at a 7% profit margin.

Families of auto accident victims are hoping for similar bills from Senator Curtis Hertel Jr., D-East Lansing, and Rep. Doug Wozniak, R-Shelby Township, to extend the 200% reimbursement to rehab facilities.

Governor Gretchen Whitmer, a Democrat who signed the bill, has said she is open to a “targeted approach” but the legislation appears to be dead for now.

Republican Senate Majority Leader Mike Shirkey said the law should be fully implemented before changes are considered.

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“We will not take any suggestions that would increase the costs for drivers, especially if we lack the data necessary to evaluate such proposals,” he said in March.

Wozniak, an attorney who has focused on Medicaid’s senior law and planning, said the fee schedule creates a situation where those who charged fair prices in 2019 have to close, while bad actors who charge more will survive.

Insurance companies are the winners because if people can’t afford to receive care and experience lost income, they will switch to Medicaid coverage and the state will do the bills, not the insurance companies, Wozniak said. He estimates the state will cost $ 72 million in the first year.

According to a survey of more than 110 post-acute care facilities commissioned by the Michigan Brain Injury Provider Council, more than 6,000 patients will lose care if the fee schedule is not changed. According to the survey, 90% of the institutions expect a total of around 4,000 jobs to be lost.

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Lane and Emily Bargeron, of Lansing, are among the families who receive 24/7 home care following a car accident in 2012. Lane had a traumatic brain injury and an exercise capacity that resembled a malfunctioning quadriplegic.

With two children and one on the way, the importance of home health care is priceless, Emily said. She worries what will happen if her family is left out of care.

“We’re going to be pretty much alone for the rest of our lives, that’s a big problem,” said Emily. “It affects every area of ​​our life, especially if we want to thrive and survive as a family unit and just live as normally as possible.”

Insurance Alliance of Michigan, an insurance industry group, expects 25 new auto insurance companies to begin coverage in the state due to the physician fee schedule, which will increase competition and reduce rates.

Executive director Erin McDonough said rates are already lower due to the expected medical savings. The alliance supports the fee schedule until the end ” tremendous overload “From health care providers, the group said.

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The fee schedule is a kick in the teeth for the provider industry, said Tom Constand, president and CEO of the Brain Injury Association of Michigan. The idea of ​​waiting to see if patients lose care and then act is about as dangerous to human life as removing a stop sign and checking to see if it has an impact.

“I refuse the other side, the Insurance Alliance of Michigan, to scourge the entire provider industry as a crook,” said Constand. “These people take care of individuals. They are humanists. You take care of these people who need care every day, toilet, shower, bath, all essential elements of care. “

Copyright 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed in any way without permission.



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