HUDSONVILLE, Mich. — The family of a 20-year-old man living with a traumatic brain injury and autism are desperate to figure out a way to maintain the level of medical care he needs, as the most recent portion of Michigan's no-fault auto reform law threatens to cut off his access.
Zach, now 20, was born with non-verbal autism, but also suffered a traumatic brain injury from an auto crash as a child. As a result of that crash, he has near-constant pain which prompts frequent self-injurious behavior.
At the time of the crash the family paid for an insurance policy that promised unlimited personal injury protection if needed. Because of that, their insurance policy has paid to cover any reasonable costs incurred in the process of medically caring for Zach.
Their policy was with Titan Insurance, which is now under Nationwide.
With the most recent portion of Michigan's no-fault auto insurance law going into effect on July 2, insurance companies don't have to reimburse care providers the way they had been.
Any medical service not already covered under our federal Medicare law, which includes in-home caregivers, will now only be reimbursed by insurance companies at 55% of what they were back in 2019. The law also caps the number of hours that family members can provide care to just 56 hours a week.
“We're really looking at a situation where he's going to injure himself, he's going to injure one of us, and it's just going to go spiraling downhill from there,” Zach's father Greg told FOX 17 on Wednesday.
"He tries to bash his head in with either his fists or against a wall or floor, so, what it requires is for people to intervene."
When he was younger, just 1 caregiver of decent size was enough to take care of Zach, physically intervening when necessary. As Zach has aged, he has of course gotten bigger, making the process of intervening when he's hurting himself all that more difficult.
Between 13 caregivers, including mom and dad, Zach requires about 504 hours of care per week. This is accounting for their need for 3 caregivers at all times.
For many years, their insurance company paid the family's caregivers as independent contractors. About 3 years ago, his mom formed ZMC Services LLC to locate caregivers who were big enough to care for Zach, and so that their insurance company would reimburse them for administrative costs they were previously covering mostly out-of-pocket.
"We had to set up our own agency in order to hire strong enough people to deal with him. Now, when we did that, they refused to pay us like they would any other agency... They wanted to say that because they used to pay people as independent contractors, they should still be able to get away with that, even though it avoids employment taxes, and all the other benefits and protections like workers comp that comes with that," Greg explained.
"And we've been losing money hand over fist ever since trying to keep this afloat until we can get us a fair rate agreed to."
The family already had trouble getting their insurance company to reimburse their costs prior to the July 2, 2021 law change. They are now terrified at what the slash in reimbursement rates will mean for their financial situation.
"Now with this law change, they are going to try and use that excuse to say that because his mother started the agency that anything above 56 hours, because she hired the people, anything above 56 hours is not anything they have to cover anymore," Greg said.
Both mom and dad have both recently left full-time careers, and taken out a 2nd mortgage on their home, in an attempt to cover payroll and other administrative costs associated with caring for Zach.
“He is going to die... this is not just a joke," his mom said Wednesday. "We'll lose our home on top of it, but Zach will die… and in a horrific manner.”
According to emails shared with this reporter, Nationwide has offered little in terms of a solution to the family's life predicament. While they have suggested the notion of admitting Zach to an in-patient facility, his parents say they have already looked into this option and found no facility in Michigan that would be able to admit their son.
While any of the legislative fixes already in the Michigan legislature would provide them with a fix, the family is hoping now that Nationwide will decide to fully reimburse them for all costs associated with Zach's care.
Greg explains, “All we want is a fair market rate, and be treated like any other agency, and not be subjected to this 56-hour rule, which should never have applied to us in the first place because we paid full price for unlimited care, and that should be what we get.”
