MULTIPLE questions about a terrible car accidnet and the medical/legal fallout.

September 7, 2007 12:01 PM

My brother and his wife were in a near fatal car accident in California while on vacation. I need to get them about 200 miles back to Las Vegas. I have MULTIPLE questions, and I hope you guys (and gals) can help...

So, a head on collision at almost 65 mph and they're alive. Extensive injuries, but it looks like they'll both pull through (after a combined 10 surgeries). I have multiple questions, but the first is how to get them back to Las Vegas without spending $4000 on an ambulance.

They had both just quit their jobs and were on a long needed vacation, so no personal health insurance. They both were covered by $150,000 a piece medical, and the other driver had $50,000 per person medical coverage. It was the other drivers fault, he died at the scene.

This happened almost 2 weeks ago and I didn't even think to ask the smartest people I know what the hell I should do next. We have an attorney who is looking at our options as far as litigation goes, but the pressing issue is getting them out of the hell hole town in Western California without personally bankrupting my family. I called 2 ambulance services, and they don't seem to like "claim numbers" much.

posted by lattiboy to health & fitness (43 comments total)

Are they physically able to be transported to a new hospital or are they being discharged? Have you spoken to a patient representative at the hospital? Usually they know of regional or community transport programs. Without insurance, it's not going to be cheap.
posted by mattbucher at 12:07 PM on September 7, 2007

I would see if the hospital they are at has some kind of ombudsman or patient advocate. People like that probably have know how to call and how to accomplish such a task.

I know often this happens where a patient is transferred to a hospital closer to home when they are stable. I mean, it might end up costing a lot, but I am under the impression that it "goes on the bill", not that its something that will have to paid right then like a taxi.
posted by stormygrey at 12:09 PM on September 7, 2007

Are they physically able to be transported to a new hospital or are they being discharged? Have you spoken to a patient representative at the hospital?

My brother was discharged yesterday, but his wife won't be discharged for another week. His left leg and arm in immobilizers (sp?) and he is very weak. His wife is in much worse shape (both legs and arms), but is getting better at an impressive rate.

The hospital has been HORRIBLE in almost every way. We found out two of the nurses weren't giving my brother enough morphine because he was being difficult (three nurses were given reprimands), the doctors are never available, and a bunch of $10 an hour LPNs seem to be the only people you can ever talk to and I seem to have more medical knowledge from watching House regularly.

It seems almost impossible that we're being looked at to provide transport to people who cannot sit upright for any period and have fresh rods and pins throughout their bones.
posted by lattiboy at 12:14 PM on September 7, 2007

seconding the patient affairs office or ombudsman. you might also want to call the insurance company and see what they cover and what the process is.
posted by thinkingwoman at 12:20 PM on September 7, 2007

If they quit their jobs and had insurance before, they might have COBRA now. Checking with whatever employer had their insurance before (or having your brother call and check, if he's able) would sort out whether this is the case pretty quickly. Secondarily, contact the insurance company that is covering the medical payments - their car insurance, or the other guy's, and see how that claims process works.

Basically, this is not going to be cheap. You may be able to find someone in your community who has a van that is set up to transport people with disabilities. My dad found a guy with a handicap van to get my mom home from the hospital two years ago, but she was very very tired by the time they got home (~1 hour). If your brother and sister-in-law are in such bad shape, an ambulance ride might be the best and safest thing, but will probably never be cost-effective.
posted by Medieval Maven at 12:27 PM on September 7, 2007

If they both just quit their jobs, is it possible they are still covered under a COBRA insurance extension?

If not, your only option may be to front the money, or have them do so, with hopes that there's a claim to be made against the other driver's estate.
posted by beagle at 12:28 PM on September 7, 2007

You can usually enact COBRA after the fact, which is strangely out of place for medical insurance.
posted by kcm at 12:28 PM on September 7, 2007 [1 favorite]

Beat me to it, Maven.
posted by beagle at 12:28 PM on September 7, 2007

Have you looked into regional "safe ride" non-emergency medical transport services? These are common in rural areas, and would probably not cost $4,000, but have no life support systems.
posted by M.C. Lo-Carb! at 12:31 PM on September 7, 2007

Ahh, the US health system. Call the insurance company that covered your brother & his wife.

Of course, this assumes their policies covered them while away from home -- they may not, in which case you are probably screwed and will need to front the money.
posted by aramaic at 12:32 PM on September 7, 2007

Good point, kcm. It looks like you have at least 60 days after loss of coverage or notification of COBRA eligibility from prior employer to enroll. (Individual plans may offer a longer window.) This will entail paying a monthly premium, of course, but it may be an avenue toward getting 18 months of rehab paid for.
posted by beagle at 12:33 PM on September 7, 2007

Thirding COBRA ... since the hospital is being unhelpful, and regular ground transportation sounds like it's not an option, I think you are either going to pay a lot of money out of pocket, or you're going to have to get one of the insurance companies to pick up the tab. I don't think there's a really cheap way to do it; if she requires an ambulance, that's going to be pricey. If she just needs a van or limo, that might be cheaper.

You said you have an attorney working on this -- why don't you talk it over with them? Make sure that they know that getting out of the crap hospital is a priorty. He/she might be able to give some suggestions on who's going to be most willing to cough up the cash. But unless you can come up with some medical reason for the transfer, it may be difficult to recover the cost from an insurance company or claim against the faulty driver's estate -- they may not see it as a 'medical expense.'
posted by Kadin2048 at 12:34 PM on September 7, 2007

It sounds as if the care they get when they get back to Vegas will be better. Can you contact that hospital and/or their doctor there? Would they be able to arrange something?
posted by Atom12 at 12:38 PM on September 7, 2007

To everyone reading this thread: now is a good time to check that your personal insurance policies cover your transport home in the event of an illness or accident. Even "travel" insurance policies don't always contain these clauses.

If yours doesn't have it, you should seriously consider adding transportation coverage. Go on, check right now. I'll wait.
posted by aramaic at 12:42 PM on September 7, 2007

Thirding COBRA

Thanks for all the replies folks.

First, they didn't "just" quit their jobs. Its been about 2 months or so, and they were on the way back to start the job search with some conviction. I'll see about the COBRA, but I think it may have been past the dates.

They talked to the patient advocate for the hospital and he was hardly even literate and gave them the wrong info for both wheelchairs and medical suppliers. It is really amazing to see how inept, heartless and downright fucking stupid this place is.

More to the point: If we can't come up with $8,000 for two ambulances are they pretty much STUCK??!?!? This seems just impossible that there isn't any kind of a state or local program for this. What if they didn't have people willing to give up all their money and time to help???

PS We thought about going the conversion van with mattresses route, but it seems like a dangerous and terrible idea.
posted by lattiboy at 12:47 PM on September 7, 2007

Might I suggest that, while you get these other issues worked out, you try to move them to a hospital closer to their current location? Remember, your alternatives aren't the crap western one and one you know in Nevada; there are lots of other options, and if they're getting substandard care (sounds like it) you can make things easier on them AND you by transferring them to a better place (assuming you can get a recommendation.) Perhaps meFis can make recommendations if you tell us the region they're in.

Seconding the "van with mattress" route as a terrible idea, just because of the risk. In fact, the more I think about it, the more I think everyone (and your pocketbooks) will be better off transferring to a better hospital in the region, and saving the long-distance travel for when they're able to fly or ride in a car comfortably.

Oh, and by the way: sorry to hear about the accident, and I hope everyone heals quickly.
posted by davejay at 12:57 PM on September 7, 2007

Oh gosh, yes check on COBRA. You can enact after the fact, and its from the time their coverage runs out, not the date they left their jobs, but do this AS SOON AS POSSIBLE. Then contact that insurance agency.

If you or someone close to you has an Employee Assistance Plan through your office, call that. They have answers to all kinds of things.

Also, consider discussing this with the patient advocate at the hospital who will care for them when they return to you. Or their personal physicians, if they have them, to see what the recommend.
posted by dpx.mfx at 12:59 PM on September 7, 2007

This seems just impossible that there isn't any kind of a state or local program for this.

There are a few charities that provide non-emergency medical transport, but you may have to be indigent to qualify. For example, PatientTravel.org. I'm not aware of any state-level programs in your area, and it's somewhat doubtful any charities will take your case.

Have you contacted a non-emergency medical transport company, like Ameritrans? They'll be cheaper than an ambulance, and still allow transport on a stretcher.
posted by aramaic at 1:00 PM on September 7, 2007

On a different point: if the other driver is at fault, then he is liable for covering the full expense of your brother's medical coverage. If this exhausts the other driver's insurance, then your brother should sue his estate for the rest.

You need to see a lawyer about this immediately, because you need to get a claim filed before his estate goes through probate.
posted by Steven C. Den Beste at 1:01 PM on September 7, 2007 [1 favorite]

Likely not applicable, but let's take a shot ...

Various credit cards come with Travel Medical Protection. For example American Express has such coverage for their Platinum, Centurion and Business card holders (example here). Some cards cover medical evacuation (including helicopter and/or jet service -- air ambulance transport --back to one's home).

Since they were on vacation and likely used credit cards at their destination, check to see if their cards have any such benefits.
posted by ericb at 1:02 PM on September 7, 2007

Rent an RV. You should be able to do a one-way rental. $350 to $400 plus milage.
posted by Gungho at 1:02 PM on September 7, 2007 [1 favorite]

Maybe ask for advice from the (better-quality) destination hospital in Las Vegas.
posted by JimN2TAW at 1:04 PM on September 7, 2007

so, the 150000 coverage was med pay on their vehicle? is it with a company that would have offices in California? An agents or claims office for their insurance company might be useful since they are local and more aware of the services available, as well as what coverage might be. I don't think medical payments can be subrogated, but you might be better served using their own coverage for this part of the deal, just to get help.

good luck.
posted by domino at 1:07 PM on September 7, 2007

Not certain where in "Western California" they are, but here are a few non-emergency medical transport companies you could contact for quotes:

MedEx Transit, Inc.
Hey Taxi!
AA Med Trans

Best of luck to you and your family.
posted by clpage at 1:10 PM on September 7, 2007

They both were covered by $150,000 a piece medical

Maybe there's something basic here that I don't understand, but if they are incapable of being transported by conventional modes of transportation, wouldn't their "medical transport" be covered by this $150,000 medical? Presumably they are on their way to receive other medical treatment, right? Can't this be rolled in with their other expenses?
posted by jayder at 1:12 PM on September 7, 2007

The fact that your brother and sister-in-law are being discharged from the hospital leads me to believe that riding in an ambulance is not medically necessary. (If you have been advised that it is, please disregard the rest of my answer).

200 miles is only four hours at an average of 50 mph. With sufficiently strong painkillers, the right vehicle, a careful driver, and someone who can reliably and attentively attend to them, the trip may not be as bad as you fear. Uncomfortable - yes; but not unbearable. While a conversion van with mattress isn't a great idea, how about an RV with two beds?
posted by googly at 1:13 PM on September 7, 2007

lattiboy - stop dealing with the advocate at the terrible hospital and contact whatever the largest hospital in Vegas is. Explain the situation and see what their patient advocate would recommend.

re: COBRA in general: It would definitely behoove you to at least check on this. Contact the HR department at both their prior employers.

Also are they from Vegas originally? Vegas residents? If it were me I would contact both their prior employers plus the folks at the Vegas chamber of commerce (if they're Vegas residents) and explain the situation. Its not unusual for large companies to use their (otherwise sitting unused) corporate jets to fly folks with medical needs from one place to another, because it gets them good press and also they can deduct a portion of their upkeep on the jet this way. I have a friend of a friend whose daughter was flown from far northern Maine to Boston for medical treatment in just this way.

The State of Nevada has a Long Term Care Ombudsman's Office. While they're geared mostly towards the needs of Seniors, they may be able to direct you to another resource or agency that could help.

Good luck and best wishes to you and your family.
posted by anastasiav at 1:14 PM on September 7, 2007

Discuss getting a payout on the collision suit now with the attorney--insurance companies will purchase the rights to your claim if it is strong. It is called litigation financing and it could help you out in a jam.

As for transporting the pair, do exactly what is ordered by the doctors.
posted by Ironmouth at 1:15 PM on September 7, 2007

googly - my mother, who was life-flighted to an ICU, was discharged from the hospital and absolutely could not ride in a conventional car. An RV, maybe - but you're going to have to think about how to get them up the stairs.
posted by Medieval Maven at 1:18 PM on September 7, 2007

I vote for the RV, too, it's not as bad as you might think
posted by matteo at 1:28 PM on September 7, 2007

I think the RV and fashioning some sort of ramp so that you can push them in a wheelchair into it without them having to walk up the stairs might be your best bet.
posted by whoaali at 1:33 PM on September 7, 2007

Potentially a long shot, but try contacting their elected officials in their home district, as well as their social services agency. I don't suppose either are ex-military/ex-police? (Thinking along the lines of good press, organizations that have ideals of brotherhood, etc...)

My deepest sympathies to all involved.
posted by desjardins at 1:37 PM on September 7, 2007

Have you talked to the surgeon or doctor? Insurance will pay for transport if it is "medically necessary." "Necessity" has a flexible definition and can often be influenced by the doctor. The doctor may determine that your sister in law requires something that the current hospital cannot provide, thus making transport to another hospital necessary. Obviously, this would require a cooperative doctor but most of us grease the wheels of the system like this all the time. It's worth discussing at least, also the doctor would have a better idea of how safe it would be to move a patient. Sometimes you just can't.
posted by Slarty Bartfast at 1:41 PM on September 7, 2007

It's been said already, but it should be said again: call their former HR departments immediately, before they all go home for the weekend. COBRA is likely still available.
posted by Lyn Never at 1:44 PM on September 7, 2007

One must apply for COBRA continuation within 60 days of a "qualifying event" (in this case leaving their jobs), or receiving the "election notice" from the benefit plan administrator, whichever comes later.

So, given that it's been "about 2 months or so," it may be too late, it may not be, but either way it's going to be a close call, so you need to look into it NOW.

From the Department of Labor's FAQs About COBRA Continuation Health Coverage:

How long after a qualifying event do I have to elect COBRA coverage?
Qualified beneficiaries must be given an election period during which each qualified beneficiary may choose whether to elect COBRA coverage. Each qualified beneficiary may independently elect COBRA coverage. A covered employee or the covered employee's spouse may elect COBRA coverage on behalf of all other qualified beneficiaries. A parent or legal guardian may elect on behalf of a minor child. Qualified beneficiaries must be given at least 60 days for the election. This period is measured from the later of the coverage loss date or the date the COBRA election notice is provided by the employer or plan administrator. The election notice must be provided in person or by first class mail within 14 days after the plan administrator receives notice that a qualifying event has occurred.
posted by pardonyou? at 2:00 PM on September 7, 2007

Are they going to need nursing care once they're home? Like, is someone going to have to change bandages around the rods or keep track of meds? Will someone be taking care of them at home?

Because if the care they need is significant, your best option might be a low-level care facility (think nursing home for injured people) near your home. See how much private nurses v. a care facility will cost. The care facility most likely will also help you with transport. If nothing else, maybe a care facility can answer some of your questions and tell you your options.

Best of luck to you and your family.
posted by cooker girl at 2:59 PM on September 7, 2007

If talking to a Vegas hospital doesn't help, see a car insurance lawyer. Larger law firms will often pay something like this for you, with the idea that they'll get it back at the end of the claim. They may also be able to suggest the best route for tackling this.
posted by acoutu at 3:40 PM on September 7, 2007

There is an organization called Angel Flight (http://www.angelflight.org/) that may suit your needs. I am not sure if they are generally equipped to transport people in their condition, but if not, maybe they would be connected to other resources who are. Good luck!
posted by eiramazile at 4:56 PM on September 7, 2007

Might not hurt also to call their/your Members of Congress offices. Try both Rep and Senate, and call the local offices first, not the Washington offices.

Not that they could force anyone to do anything for you, but they might know of some local government agency or non-profit service org that could help you.
posted by mccxxiii at 6:14 PM on September 7, 2007

Angel Flight's list of charity air transportation (maybe some provide non-air transport too?)
posted by IndigoRain at 6:24 PM on September 7, 2007

THANKS so much guys. We ended up getting a bus-limo for $600 that has two beds in it. I can't believe they did it for so little (they must have had a pickup in Vegas). I really appreciate all the input and I'll look over all the answers tonight!
posted by lattiboy at 7:26 PM on September 7, 2007

My brother was a student in Nashville,TN, and had no insurance, and was in a serious accident that left him paralyzed. I immediately enrolled him in TennCare (Tennessee Medicare), and they covered everything, and were very helpful. Bought him a wheelchair, put ramps at his house, outfitted a car with hand controls, etc. CA probably has a decent state run Medicare system. Get them enrolled ASAP, and they will help a good bit.
posted by nikko at 7:27 PM on September 7, 2007

I'm amazed nobody's said it, but you need to contact a lawyer in CA, who would have a freakin field day with this hospital.

n'thing the COBRA and all that, but do your part as an affected consumer and make sure that the next people this happens to don't have to suffer what your family has.
posted by allkindsoftime at 6:55 AM on September 10, 2007