John Wicke has been medically stable in a hospital bed on the 8th floor of the Sparrow Hospital in Lansing for two weeks.
Any normal patient would by now be discharged to go home.
However, the reason for the 52-year-old Corunna man’s hospitalization is anything but ordinary.
Vetch can’t go home because Sparrow Hospital is the only place he can currently be fed, dressed, taken to the bathroom, and frequently moved around in bed so he doesn’t create wounds that can lead to fatal infections.
Wicke is paraplegic and was the victim of a terrible car accident in December 2009 in which he was unable to move most of his limbs.
Wicke has been living comfortably in an apartment in Corunna, the county seat of Shiawassee County, 145 km northwest of Detroit, for ten years.
Michigan’s new auto insurance law, which went into effect July 1, has turned Wicke’s years of stable care upside down by greatly reducing how much his home health insurance plan is paid by an auto insurer for around-the-clock care .
On July 20, BrightStar Care in East Lansing stopped sending a nurse and caregiver to his apartment because she couldn’t keep losing money on Wickes care, said Sonja Hoxie, a case manager at Ambrose Care Management in Okemos, an agency which has been hired by auto insurers to manage the care of policyholders.
Hoxie said she contacted every home health agency that serves customers in Shiawassee County. Most either closed their doors on the 45 percent pay cut in the new law, stopped accepting faultless patients, or only accepted them when they came with their own nurses given the ongoing labor shortage, Hoxie said.
“Medically, he’s stable and he could be discharged,” said Hoxie, who was in bed with her client in a Zoom video conference last Thursday. “However, he cannot be released home because I don’t have an agency willing to pick up his case without a tariff guarantee.”
Wicke had no choice but to become a temporary resident of Sparrow Hospital on Michigan Avenue in Lansing, about 12 blocks east of the State Capitol Building, where lawmakers made the fateful decision in May 2019 to interrupt Wickes’ daily care.
Wicke is among the at least 689 victims of car accidents whose daily care was changed by the new auto insurance law, according to tracking data from the Michigan Brain Injury Provider Council.
These are only the cases known to the MBIPC. There is likely much more out of a pool of 18,000 people who rely on the Michigan Catastrophic Claims Association (MCCA) for their long-term care.
The MCCA is a state-owned entity that manages a $ 23 billion fund to serve the long-term care and needs of people like John Wicke.
The money is still there, but the health infrastructure that Wicke and thousands of other injured motorists have looked after is being dismantled by this fee schedule.
As a result of this policy, Michigan drivers save $ 134 per vehicle annually on their auto insurance with the reduced MCCA fee.
As a result of this policy, John Wicke cannot currently live in his home as the legislature has decided not to exempt previously injured motorists from reducing payments to their carers.
This summer, case managers like Hoxie telephoned for days – not hours, days – with the experts of the insurance companies to negotiate new care regulations for these catastrophically injured drivers like Wicke.
Some of these injured drivers have relied on their families to fill the gaps in their daily care.
But others like Vetch slipped through what was once Michigan’s strongest safety net until lawmakers and Governor Gretchen Whitmer pulled the scissors out two years ago.
Hoxie said she had an agreement in principle with Wickes’ insurer Waukesha, Wis. Partners Mutual Insurance, agreed to move their client to a qualified MediLodge nursing home in the Lansing area.
But that can’t happen until the MCCA approves the new care plan.
“Without an approved tariff, nobody is going to continue their services because they don’t know what their salary will be,” said Hoxie. “The entire billing no longer goes to the (insurance) experts. It goes to the audit team (at the MCCA) that they set up.”
Something’s wrong in Wickes’ case.
MCCA Executive Director Kevin Clinton said Tuesday the organization had not received a pre-approval request for vetch.
Christopher Markley, a spokesman for Penn National Insurance, a subsidiary of Partners Mutual Insurance, declined to comment on Wickes’ case.
“In order to protect the personal and private data of our customers, we cannot answer inquiries about claims,” said Markley in an email to Crain’s on Monday.
Several case managers I interviewed last month say that insurance experts – some of them tearfully – all make the same statement: they cannot authorize new payments without prior approval from the MCCA, and the MCCA has become the only obstacle to new care plans to create.
“Tell them this is nonsense,” MCCA’s Clinton said in an email response.
In many cases, the case managers say the insurance experts approve new home care tariffs above the 55 percent statutory cap because they recognize that the cap drives providers’ tariffs lower than any home care company can afford.
“The big things that put them past the MCCA,” said Elizabeth Piner, president and owner of Ambrose Care Management.
Piner has a case with a 38-year-old Albion mother of five who became paraplegic in a car accident in April 2020.
The woman, Nakeesha Jones, has lost her caregivers and is dependent on her three teenage children to look after her in a family home that doesn’t have shower facilities, Piner said.
Two of Piner’s employed nurses, Stacey Krause and Shara Curry, have started a new home care company called RN Plus Staffing Inc. in hopes of exploiting a potential loophole in the 2019 law that only appears to apply the 55 percent rate Upper limit for companies that were in business on January 1, 2019.
As Crain reported back in May, this could be one of the tricks to bypass the 55 percent interest rate cap – just form a new LLC – although no one knows how insurers will react to this billing tactic.
“Starting a new business is the way, it’s just hard to do,” said Piner. “So whoever is new is most likely to survive this.”
On Tuesday, after weeks of fighting with Lansing Auto Owners Insurance, Piner Jones received approval to stay in a two-bedroom suite at an extended-stay hotel in the Lansing area for $ 125 a night.
RN Plus Staffing plans to immediately begin treatment for Jones in the hotel room, who requires two-person transfers and frequent bed moves to prevent her skin from deteriorating. Piner’s company planned to pay the bill for a two-man and truck-moving crew to move Jones’ medical equipment from Albion to Lansing on Tuesday.
“It’s totally makeshift,” Piner told me. “But she will survive. There we are now. We are in pure survival mode.”
Jones barely avoided going to the hospital this week.
Meanwhile, John Wicke is waiting – in a hospital bed.
Wicke’s case begs that someone in the legislature or in the governor’s office have the audacity to call insurance lobbyists on the carpet about the shortcomings of this law they wrote – and fix it.
The chaos that has developed since July 1 could be undone by 56 members of the House of Representatives, 20 senators and the governor. But they are still on their summer break.
When I talked to Wicke about Zoom, his voice was hoarse as he described his current situation.
“It’s frustrating,” he said. “I’m fine. But I want to get back to my routine.”
It was part of his routine that his nurses let him drive his handicap van to the flea market – an escape from the apartment on the weekends.
“In John’s case … so much of his independence was taken from this accident and his independence that he left was his van, his apartment and the good fortune to have staff that allowed him to stay at his house “said Hoxie said. “And now you’ve stolen his last independence and snatched it from him.”