For those that don't want to fix our Healthcare system.

[Momz]

On July 31st I had a minor accident that involved just my bike and no one else. The bike was rideable and my wife rode it home from the accident scene. I however had to be taken to the Hospital with a broken clavicle, broken ribs and a severely bruised left hip.

My healthcare insurance company is AETNA. I was told that my injuries were covered although I had to pay my deductibles,...(fair enough). My orthopedic MD did several x-rays and checked me every three weeks so as to check the healing process.  He then wrote a prescibtion for Physical Therapy.

Well today I got a call from the Rehab facility that the PT is no longer being paid for. I opened my mail this afternoon and found that AETNA is not paying my Emergency visit, EMS ride, X-rays and orthopedic exams.

I called AETNA about this and they said that my auto insurance is responsible for those charges. I told several insurance representaives on the other end of the phone that my accident was not in an automobile, but on my motorcycle.

I have full coverage through Progessive, but in my state motorcycles are not covered under our states "no fault" laws. So now I'm responsible for all the medical costs that are incurred because I was riding a motorcycle that was not involved in an accident that involved another person or vehicle. Progessive does offer medical coverage, but discourages it do to the excessive costs.

It seems to me that this is the biggest bunch of crap I've ever heard of. They take your money, but refuse to pay when you need them most.

[Mikey]

Did you tell them it was because of a motorcycle accident in writing? (police report) Otherwise I'd tell them you fell down the stairs, or fell off a ladder or something. I don't encourage being dishonest, but sometimes being dishonest is the only way to get honest treatment.

[SgtBunny]

Sorry to hear about your your problems Momz but it is not healthcare that will fix your problem, but state law and insurance policies that have you screwed.

If we go to the govnt ran health care system then you would still be waiting for an appointment or denied all together.  Just look at the VA system.  I have been working 2 years to get in to file my claims and they keep rescheduling my appointments.

[fstsix]

If you have the motorcycle and auto with the same company' your auto med"s will sometimes cover over to your motorcycle. Gieco does this. Maybe some one will jump in on this subject.

[asfltdncr]

The need to change the insurance industry is equal to our need to change Health Care. Insurance companies are in collusion with one another and we don't have control over the premiums, exclusions, and co-pay.  The only way to gain any leverage is to offer an alternative to the conventional.  Then insurance companies will have to compete for for your business and their own existance.

[f6john]

   Does your state have an insurance commissioner that regulates insurance companies? Sounds like a call is in order.

[2tonevalk]

The low down is this.  I dont live in Michigan but if it is like about anywhere else I have lived.   Aetna is assuming you have medical coverage on your motorcycle.  If your motorcycle has medical coverages, that will have to pay first and be exhausted.  Then your Aetna will cover after they pay first.  
However again, this is most likely the scenario.  I know my Progressive has 50,000 bodily injury on it.  If I get injured on mine.  This has to be used before my insurance from work will kick in.  Do a little research and I hope you find you dont owe as much as you think.
Best of wishes on a speedy recovery.
Robert

[fudgie]

Most if not all 'vehicle' accidents are covered under the auto policy. What it doesn't pay should go to AEtna, which SUX imho, and should take care of it. This is how we bill for our EMS runs. Most have car insurance but no health. Not sure why it doesn't for you. Try harder. Also make sure the hospital tries and pushes it thru again for you. I know they want their money!

[Duckwheat]

There is no way that is true. If your auto is not primary you r health insurance will cover it.

I sold insurance for 12 years. There is no way they can do that. You have not done something to let them know or have not got to the right person yet. Get past the idiots and get it taken care of.

DW

[G-Man]

I'm sorry to be the negative voice and I surely don't want to offend anyone but I see nothing wrong with the way the original poster was handled. 

1st, he didn't say how the accidient that involved no other vehicle or person happened or what was invloved.  Oil on the road, slick road, etc all acceptable.  Trying to do a wheelie, maybe not.

2nd, insurance is a gamble.  You are the palyer and the company is the house.  You are betting that you will get into an accident, they are betting you won't.  If you choose not to carry the bodily inury part of the motorcycle insurance, then you are betting that when you do get into the accident, you won't get hurt.  The cost of the bodily injury insurance doesn't matter.  You chose not to take it, you gambled, you lost.

3rd, the other posters are correct, your health care insurance carrier would not be the primary.  They also may try to denie the secondary claim because they can show that you made the choice not to carry bodily injury insurance within your motocycle insurance.

Fair is fair in this case, at least the way it has been presented.

[Bob E.]

My guess is that Aetna has denied coverage because they are saying that your auto/moto insurance should be the primary and pay first...then they would pick up what is not covered.  We just had the same thing happen where my employer switched to BCBS from Cigna.  Well, my wife had to go for a blood test and BCBS denied payment.  Their reason was because they wanted to verify that she didn't have any other insurance first.  After a quick phone call to BCBS confirming she had no other insurance, they approved payment.  I'm guessing that Aetna is playing the same game here.

G-MAN...If what you are saying is true, that is clearly a demonstration as to why our insurance industry needs a complete overhaul.  Momz clearly has health coverage that should cover his injuries....no gambling here.  Why should he have to pay double for bodily injury on an auto/moto policy??  Bodily injury should be for those who do not have other health coverage....then you should get bodily injury.  I doubt there is anything in his health insurance policy that would exclude coverage for injuries resulting from a motorcycle accident.  What if he had gotten hurt while skiing...should he be carrying skiing insurance??  What if he fell down the stairs...should he carry walking insurance??  That's a load of crap!

[G-Man]

Bob, you're right.  We certainly do need an insurance overhaul. 

[Jabba]

IMO how they SHOULD do it is the auto/MC bodily insurance should pay 1st, and health insurance 2nd, and he should pay NO deductables because he was DOUBLE insured.  I think it's crappy that they do what they do.

I had double health insurance for a while... and playing them back and forth against one another got to be such a hassle I quit doing it.  If my secondary insurance company would have crap up, and paid, essentially my deductables, they would have gotten paid as aprimary insurer and only paid out as a secondary insurer.  But they were so difficult to work with that I eventually made them my primary so that I didn;t have to screw around any more. 

Dumbasses.


Jabba

[Bob E.]

Being double-covered can be a big pain in the ass that puts you in the middle of 2 insurance companies that say the other should pay.  My step-daughter has a disability and qualifies for state insurance through the CHIP program.  On top of that, I have insurance at work that was double-covering her.  Well, we had so many issues with being caught in the middle between the two insurance companies saying they weren't going to pay that I eventually dropped her from my insurance and now she completely rides on the state. 

One of the issues we were having was that my insurance and the state insurance have different provider networks.  Well, her mental health provider (which is her disability) is not in the same network as her pediatrician...but they had to coordinate between them for medications, etc.  Well, her psychiatrist had prescribed medication that required quarterly blood tests.  Well, for whatever reason, the psychiatrist hadn't prescribed a blood test for awhile, and my daughter was seeing the pediatrician for a general annual check-up.  Since it had been a while since she had a blood test, the pediatrician prescribed one.  So we went to the blood lab to have her test done...the same blood lab we had always gone to in the past for this test.  Well, the lab was on the same network as her psychiatrist, but was not in my insurance network.  Well, my insurance refused to pay because the lab was out of network.  So we figured no problem, we'll submit it to the state insurance since it is in their network.  They refused to pay because the prescription was written by a doctor that was out of network.  That fiasco cost me close to $300 out of pocket for a medical procedure for someone who was DOUBLE COVERED!!!!  That was the last straw.  I dropped her from my insurance, and she gets a free ride on the state.

[Jack]

I was in a bad wreck over 2 yrs ago.  The hospital (my wife was an employee) refused to file my bill and insurance thru medical and I (and the person who hit me) had no medical attached to our vehicles.  Everyone was paid except the hospital so, of course, they came after me.  My lawyer(everyone should have one) did not even charge me to handle the problem.  I haven't heard from them in over a year.  My wife has also changed employers.

[Momz]

Aetna has informed me today that in no way will they pay for any medical treatments or EMS transportation due to my M/C related accident. They claim that MI's no fault insurance regulations allow them to deny payments.

Motorcycles are not covered under this states "no fault" regulations if their is no other vehicle involved. Had I ran into another car, truck, M/C, or pedestrian then they would be liable to pay for at least some of my medical bills.

They also stated that since I am disabled that I should never have been on a motorcycle. That same Aetna  person said that they will persue through our Secratary of State office to severely restrict my drivers license.

Heathcare/Insurance reform is sorely needed. I'm not saying that we need to follow the British or Canadian type of universal healthcare system, but I know that we can do better without screwing our citizens.

[Varmintmist]

You need to call the insurance commisioner. Unless there is something in your policy that specificly states that they are not required to cover you because you were in a lone bike crash it sounds like a bunch of smoke.

The since you are disabled you shouldnt be on a bike is one of the reasons that most folks dont want govt. health care. They have zero to do with what you do. It's like that brit guy with the arm, they refused to do surgery the second time because he smoked. Its control of your life and decisions on how you are to live. If they want to not cover riders, fine, state that up front. For life insurance they will ask if you are a student pilot, if you are, they won't write the policy.

[mikeb]

They also stated that since I am disabled that I should never have been on a motorcycle. That same Aetna  person said that they will persue through our Secratary of State office to severely restrict my drivers license
THIS STATEMENT SOUNDS LIKE DISCRIMINATION TO ME  GET EM GEORGE 

[Mickey Runie]

You might give this guy's site a look see.  Looks like there's a free Q&A form on the site.  Can't hurt to ask.

http://www.michigan-auto-attorney.com/michigan-no-fault-benefits.html

Seems like your med policy would HAVE to cover you when/if your bike insurance didn't, unless the policy specifically excludes bike accidents from the git go. 

Different state, scenerio, and half a lifetime ago, but I got knocked off my scoot by an underaged newbe blonde cage driver.  Her ins co kept claiming my "check is in the mail" for over 6 flipping months.   They never would of really mailed a check until I had that lawyer write them a letter.  Had a check within 48 hrs after he got involved.   S.O.B. charged me 1/3rd of the settlement for a 5 minute letter, but what's a man supposed to do otherwise?

The least you can do is find a different ins co to pay premiums to if Aetna won't make good on their policy. ?
Good luck

[Oss]

George  stop messing around and call the michigan lawyer NOW

I am not admitted in Michigan but I had 2 accidents one in Ct and one in NY both with no other vehicle  OIL on the road both times.
1st one totalled the bike altho I drove it home and the 2nd no damage to the bike that you could see. Ins pd ems and hospital and dr in the 2nd one as I wasnt hurt in the 1st which was at highway speed

Progressive was really good but then I have FULL coverage, all the bells and whistles including med payments.

IN NY the problem with no fault is you either need another vehicle involved that HIT you or you must claim a hit and run or run off the road.  

You have nothing to lose by emailing that lawyer right now

Say hi to that lovely wife of yours for me and hope you recover completely and soon

Oss