Patients and care providers caught in prolonged stare down over insurance

By now, you may have seen or heard by now the heart-wrenching story of Kelley Miller.

She's the quadriplegic who is among the 18,000 catastrophically injured patients forced to adjust to the new law that puts serious cost controls on a system that —until recently — had few to none.

Her nurse, now apparently unable to afford to take care of Miller, watched her patient get moved from her home, where she lived with her husband and some animals for the last several years, to Sparrow Hospital, where she will receive the 24/7 care she needs to live.

The story is relevant now that House Speaker Jason Wentworth has decided that he will not consider any further changes to how care providers will be compensated for treating those people, like Miller, whose serious car wreck injuries require constant care.

The 45% cut to providers — created by the 2019 reforms — will stand. The medical fee schedules on attendant care will stand.

To the casual observer, the move seems heartless. How could a government official tear suffering individuals out of their homes and their long-term care providers? Surely, there's something that could be done.

Folks like Miller are covered by the unlimited lifetime care insurance policies we all bought up until a couple years ago, right?

The answer to all this requires some explaining. And in the public relations world, the moment you're explaining, you're losing, which may be why Wentworth and other legislative Republicans aren't engaging in the topic.

What's happening is a continuation of a drawn-out back-and-forth between legislators (and by extension auto insurers) and those who take care of catastrophically injured patients (and by extension patients).

You may remember that for years, rehabilitation clinics and care providers created were able to charge essentially whatever they wanted to their services for auto wreck patients.

This isn't like medical insurance. This isn't the haggling your physician and Blue Cross or PHP go through in figuring how big of a bill you're getting for your medical procedure.

This was: Bill sent. Bill paid.

This meant the Michigan Catastrophic Claims Association, which all drivers used to pay into, saw rapid increases that hit $220 per year at one point. After the cost controls went into effect and payments were limited to 55% to 78% of prior charges plus 5.39% (the rate of inflation), fees were down to $86 a year.

That $400 check we're supposed to be getting from our auto insurance company? That's directly related to the new cost controls on folks like Miller. There's so much money in the fund that you're getting a refund.

If you don't like it, you can donate your $400 refund check to the Brain Injury Association to help care for the injured. Or you can spend it however you please.

Rep. Phil Green, R-Mayville, and other legislators have suggested that a different fee schedule be used to control costs. What about paying what workers compensation pays or veterans affairs pay?

Neither of these fee schedules takes into account the costs to provide 24/7 care, which many of these 18,000 patients need. To stretch out the same reimbursement levels that workers comp pays out to these catastrophically injured patients would be a hefty bill, which could have us all going back to paying $220 a year.

Wentworth and other Republican lawmakers are now playing poker with these providers, who they believe have been overcharging Michigan drivers for years. They see the providers as using their patients as public relations props to get back what they had.

If the 68 companies that claim they are on the verge of going out of business are truly going under, they can open their books to state insurance regulators. The state has $25 million to give providers so they don't close their doors.

The condition, however, is that providers need to show the regulators their books. What did they charge in 2018 before this law went into effect? What are they charging now?

Are these providers getting what they need to operate? Or are they not getting what they want?

The great shakeout in this market hasn't happened, yet. Until it does, folks like Miller will be staying at Sparrow until she finds someone willing to work for less.

(Email Kyle Melinn of the Capitol news service MIRS at melinnky@gmail.com.)