AvMed Insurance Complaint - State Workers Beware of Avmed

Review by Anne72 on 2012-01-23
GAINESVILLE, FL, FLORIDA -- My daughter is a state worker with Avmed insurance. On the 11th of this month my granddaughter was in a car accident and suffered traumatic brain damage. After she was in Shands for approx. 8 days. and substatial recover, her doctor said that she needed intensive rehabilitaion at the rehab center. Her family was shocked to learn that Avmed would not cover the $1200 a expenses for inpatient care--the only way that a complete recovery might be possible. Instead she could get 90 outpatient visits paid for. At 3 per visit (speech, occupational, and physical), it ammounted to only 30 days (probably 3 days per week). The news was devastating, expecially when we found out that the policy coved inpatient drug adddition. That is a travesty. Fortunately, her doctor knew that my granddaughter, who still could not walk and could barely use her left side) had to have the intensive inpatient, so he refused to discharge her from the hosp. stating that he would keep her there for what therapy they could offer as opposed to the outpatient. Since that would cost Avmed more than the rehab. they agreen to pay the cost. State workers, contact your respresentatives and senators and demand that the contract with Avmed or any other insurance offered to state workers cover a rehabilitation hosp.
Comments:2 Replies - Latest reply on 2012-01-23
Posted by Johanna on 2012-01-23:
If she was in a car accident, was it the fault of another driver? If so, their insurance should pay for her treatment. If it won't, then you take the driver to court.
Posted by At Your Service on 2012-01-23:
That's easier said then done clutzy. Not that I don't agree with it. A bigger difficulty is that many state laws only mandate that the driver carries $100,000. in liability insurance. That can be eaten up quite quickly with several days of rehabilitation, let alone keeping the young lady in the hospital for such.

The old saying that you can't get blood from a turnip sounds about right here. If the offending driver doesn't have a great deal, a judgment may only be worth the paper it's printed on. Not to mention, one is not likely to fight such amounts in a small claims court setting. Upper division courts require the costs of attorneys which, at minimum, charge a $1500 retainer.

Within a week or two, it's very possible to use the minimum liability a driver must have and then the rest of the costs land directly on the person being treated.

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