Michael's Fight for Medical Care Against Insurance Denials

Hi, my name is Barbara Capps. Mike (Michael) and I go way back, and I mean waaaay back. I was his fourth-grade teacher in 1984! We eventually, a few years ago, were reconnected through Facebook. In that reconnection, I have come to know of a very stressful situation Mike has been going through for several years now, and I just can’t NOT do something to help my former student and friend.

Michael was in several motor vehicle accidents over the last four years, all of which occurred during medical transportation services provided by his insurance except for a 2021 bus accident. While Michael was treating for injuries related to the bus accident, in January 2023, Michael was being driven by a private medical transportation vendor, and they were struck by an uninsured motorist. Both vehicles were totaled, and several new injuries resulted. The good news is that after three years of delays, Medi-Cal seems to be covering his shoulder injuries from the 2021 bus accident. The bad news is Medi-Cal is obstructing his access to care for his most serious injury. He has several back and neck injuries, but the most severe is bone spurs on his cervical vertebrae that are growing inward and threatening his spinal cord if left untreated. Shockingly, Medi-Cal isn't fully cooperating.

This year, Michael won an insurance settlement for the 2023 collision, but Medi-Cal is withholding money as a lien to reimburse themselves for costs they paid-- despite Michael not being “made whole” from his injuries and being denied most of his prescribed treatment.

Medi-Cal isn't covering his out-of-pocket costs and caused him to miss several appointments at Stanford Neurosurgery, where he treats for spine injuries. They don't cover most of his oral surgery, and a number of covered benefits that are supposed to be covered were wrongfully denied. He was denied MRIs requested by multiple doctors. Some of these benefit denials were caused by a retaliatory health plan administrator, requiring Michael to apply for a Temporary Restraining Order against that administrator. He sought help from attorneys, but in California, pursuing most cases of insurance malpractice requires a death or catastrophic injury for attorneys to be able to prosecute. His state senator is supporting his efforts to clear up the Medi-Cal fiasco, but even she is limited in a state that protects its government and insurance companies from meaningful accountability.

The medical transportation concierge contracted through his health plan, ModivCare, canceled most of Michael's transportation reservations over the past several months. Michael was dropped by some of his medical specialists for missed appointments. Just in the second week of November, ModivCare canceled Michael's return trips home three times, leaving him stranded. This often happens after they've driven Michael out of the county, sometimes hundreds of miles for medical treatment. They stranded him in Los Angeles and Palo Alto multiple times this year.

Michael needs to hire a dependable driver to take him a total distance of over 2,700 miles for medical treatment. He’s been unable to work and has a Disability hearing scheduled for January 2025. His housemates are dependent on his current and back rent to pay bills, so they are impacted too. Michael is optimistic that the Disability hearing will be favorable, but he needs help to cover living expenses and medical care until then.

Please give your most prayerful consideration to give what you would be able to help me get my friend and former student as much financial assistance as we possibly can.

--Barbara Capps