DIFS Must Stop Issuing Misleading #MICareCrisis Information and Stand with Michigan Consumers Demanding Long-Term Legislative Fix

DIFS Must Stop Issuing Misleading #MICareCrisis Information and Stand with Michigan Consumers Demanding Long-Term Legislative Fix

Recently implemented fee schedule has created life-or-death emergency for auto accident survivors who require ongoing post-acute care

BRIGHTON, Mich. – (Aug. 13, 2021) —In its recent bulletin and subsequent press release, the Michigan Department of Insurance and Financial Services (DIFS) has once again responded to the Michigan Catastrophic Care Crisis — #MICareCrisis — by providing misleading information to consumers. Not only does this information attempt to spread wildly inaccurate information — it provides cover for the insurance lobby and lawmakers, who failed to prevent the chaos that gravely injured auto accident survivors are now experiencing throughout the state, according to Michigan Brain Injury Provider Council (MBIPC) President Tom Judd. 

In its effort to “clarify the care to which auto accident victims are entitled,” Judd noted that DIFS failed to mention the most critical element that is causing hundreds of victims to lose their care and leaving families in disarray: The 55% reimbursement cap for providers of essential post-acute services, such as attendant care, has created a market in which they can’t afford to offer care in the face of a nearly 50% pay cut. 

“Families who re-designed their entire lives to provide their loved ones with 24/7 home-based care are now being told, by law, that they can only provide 56-hours per week,” Judd said. “To add insult to injury, these families—along with their claims adjusters and case managers—are unable to find coverage for the remaining hours from community providers because the 55% reimbursement cap makes it impossible for those providers to pay their staff a living wage or even stay in business altogether. It is a one-two punch that is cruel and inhumane—the results of which have created the current catastrophic care crisis.”  

DIFS recommends that consumers negotiate contracts with their insurance companies, but Judd said that’s essentially a non-starter. 

“Unfortunately, insurance companies are using the leverage of the 56-hour cap to strong-arm families into accepting reimbursement rates that are far below what’s reasonable or customary in any market,” Judd said. “In addition, these contracts include non-disclosure agreements -- and a reasonable person might ask why that’s needed. Families are being bullied by the ‘90% of Michigan’s auto insurance market’ that are considering contracting with family and friends for reasonably necessary care beyond the 56-hour-per-week limit.” 

Judd said DIFS’ response to the catastrophic care crisis -- as well as that of the Insurance Alliance of Michigan, the leading lobbying group for the insurance industry -- in these scenarios is to advise people to file a complaint with the department, as it “stands ready to assist consumers with questions or concerns regarding attendant care or any other provision of the new auto insurance law.” Unfortunately, DIFS is not legally empowered to provide the relief and response that consumers are seeking. 

“Can DIFS direct an insurance carrier to pay more than 55% of what a provider charged in 2019? The resounding answer is ‘No’. Can DIFS direct an insurance carrier to engage in a private contract that is equitable and fair to the family providing care? Again, the answer is a definitive ‘No’. A state agency cannot supersede the law,” Judd added. “In this situation, the law is directly creating the Michigan Catastrophic Care Crisis. Changing the law requires a legislative solution – that is how things work, and that fact is well understood by DIFS and Governor Whitmer’s administration. They have made this very this point in their form letters responding to patients and families who have urged them to take action.”

DIFS failed its mission to “ensure access to safe and secure insurance services fundamental to the opportunity, security, and success of Michigan residents” when it did not heed the warning of the looming care crisis and work hard to convince the state Legislature that a legislative fix was vital before July 1, 2021. Instead, Judd said, the department spent its time reassuring victims receiving care that their benefits would not be impacted by the changes to the no-fault insurance law.

“If DIFS wants to live up its mission and truly assist consumers, it needs to stand with patients, families and providers crying out for an immediate and long-term legislative solution,” Judd said. “Until they do so, bulletins and press releases will continue to gloss over the reality of the Michigan Catastrophic Care Crisis in favor of protecting a flawed law that relieves insurers and the Michigan Catastrophic Care Association of their obligation to keep their promises to their consumers – who paid their insurance premiums diligently. For too long, DIFS has worked closely with insurers, but when the situation is so dire, it’s time they work closely with consumers to ensure access to care for current and future accident victims.” 

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Members of the Michigan Brain Injury Provider Council are committed to providing high quality, ethical rehabilitation services, with the mission of achieving the best outcomes for patients. As a trade association established in 1987 and based in Brighton, Michigan, MBIPC offers resource-sharing, information exchange, professional development and education, advocacy for brain injury standards of care and legislation protecting Michigan families, and the promotion of ethical conduct. For more information, go to mbipc.org https://www.mbipc.org, and connect with MBIPC on Facebook, Twitter and Instagram.