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My Insurance Nightmare!

I lost my job after an auto accident and ended up moving to Miami to live with family. In Miami, I was able to get care through Jackson Healthcare’s clinic program for the uninsured. It was good care, but there were long waits and lots of people that needed to be served. I came back and forth to Orlando because of family there.

Then, I started having terrible health problems after being involved in three car accidents between 2010 and 2013. I had auto insurance and health insurance through the Affordable Care Act (ACA)( that started with the Pre-Existing Condition Program [PCIP]). I had the mandatory Personal Injury Protection (PIP) through my auto insurance company which covered $10,000 of my medical expenses. My policy also included an additional $100,000 of uninsured motorists’ coverage for medical expenses for each accident.

The Florida Legislature requires that people have at least $10,000 in PIP coverage, but that limit was set back in 1979. Everyone knows that medical costs have skyrocketed since 1979. That was over forty years ago! Nowadays, if you have an accident and get sent to the hospital, the $10,000 is gone in a flash!

When I got to the hospital after my last accident, I told them that I felt my neck snap. They looked at it and said that I needed to see a specialist for further tests. That’s where my problem really started. I called around in Orlando and could not find a specialist who would see me. After doing a lot of research on my health issues, I found a doctor in Germany that agreed to examine me. So, I flew to Germany just to get a diagnosis 9 days after the last accident. They gave me great care and really listened to my issues. My bill was $3,000 for several MRIs, x-rays, and a medical review of the tests by the specialist. (However, I could not afford to pay for the 6-8 hour surgery that I need.) So, I went to an Orlando area hospital to be told that I was not terminal and had to go to another country to get a medical diagnosis of my accident injuries. (No one wants to fight to get paid and that includes hospitals. I had to leave the country to get a diagnosis and self-pay to boot.)

When I submitted the $3,000 bill for the diagnosis to my auto insurance company, they refused to pay. Since my hospital visit sucked up the PIP money, it was time for me to dip into the $100,000 (UIM) coverage. However, Florida law does not mandate that auto insurance companies pay the $100,000. You have to fight to get them to pay it out. Can you believe I have been fighting and dealing with this pain since it started in 2010 and it got worse in 2013? I even traveled to Tallahassee and talked with the Insurance Consumer Advocate and Florida legislatures to try and get the law changed. The Consumer Advocate told me to get my health insurance company to pay my medical bills. I feel like that’s fraud. I’ve found, though, that many people will do just that—they will lie about the cause of their pain from an auto accident in order for their health insurance company to cover the cost of their medical bills. The Huffington Post reviewed the Florida law and said it was clearly fraud.

I had Obamacare for a long time. I recently qualified for Medicare and switched to that. However, I find that it doesn’t make a difference what insurance you have. Doctors won’t see an auto accident person. When I talked with my Primary Care Physician about my pain, she referred me to a neurosurgeon. I had to pick a neurosurgeon. However, when I tried to make an appointment, they would not see me because I was in an auto accident. They did not even ask what health insurance I had. They all said that my health insurance company could deny the claims and they would not get paid.

After the 3rd referral, I finally got to see a doctor. First, though, his staff did not want to make the appointment either. They finally made the appointment when I told them that my health insurance had given the ok for a referral. When I got there for the appointment, the staff again said that the doctor could not help me because the health insurance company would refuse to pay. (This discussion happened in a full waiting room of patients and I felt so embarrassed. They seemed to be blaming me for bothering the doctor because I had an auto accident.) Finally, the staff took me to an examination room and the doctor right away said that he could not help me. He made the diagnosis without ordering any needed tests.

I’ve written to my Medicare Advantage Insurance Plan about not being able to get medical treatment because of an auto accident and requested a written statement from them that they will pay my medical bills. I told them how I could not get doctors to see me for years because of the auto insurance situation. I do not know of any other way to get the medical treatment that I need. I had health insurance and auto insurance and still did not get any care for my injuries caused by the accidents.

At this point, I feel like I’m not an American. After a year of fighting with them, the auto insurance company said that they hired an attorney to take care of my claim. So that’s where it stands now, still in limbo. All I wanted was medical care. I don’t know what to do. I don’t feel it is right to lie to my health insurance to get medical treatment. I would have to say that I did not have any auto accident injuries so that the health insurance would pay. I don’t get why people aren’t in an uproar. I don’t like how this is going. I paid for that auto insurance extra coverage for years. It was supposed to pay for needed care in case I got seriously hurt. However, they just simply refuse to pay any bill. This will be my killer and I’ll never get the health care that I need.

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