Too poor to have an accident

David Millward decided that socialised medicine was best after his American mother-in-law crashed he

''Hi, it's John," my brother-in-law's voice said from the other side of the Atlantic. "What's up?" I replied, with a rising note of panic.

My wife is American and her mother is a 78-year-old widow, albeit a sprightly one. "Don't panic," John said, trying to sound reassuring. "Mom's been in a car accident but she is OK. She is in hospital in New Haven."

That was in September. Since then we have had calls from the hospital, the rehabilitation centre and even the family doctor. Most of them have not been about the elderly patient's welfare - just polite, and more recently rather less polite, inquiries about the arrangements for payment.

As both major political parties in the UK wrestle with how to improve the NHS, my gruelling experience suggests that going down the American route - relying on people to provide for their own care through health insurance - is not the best way. The bills, or at least most of them, will eventually be paid by a combination of Medicare - the US government safety net health system - and my mother-in-law's motor insurers. Making sure this happens has required countless phone calls, the services of a lawyer and a level of patience even Mother Teresa would have struggled to maintain.

Blinded by bright sunlight, my mother-in-law had driven into the back of a trailer. She was hauled out of the car and driven a few miles by ambulance - please pay us $500 - to hospital. Here the care was cursory. A broken knee was diagnosed. She was given a knee brace - a bill for around $87 arrived a couple of weeks later - and she was discharged within hours. This is a 78-year-old widow living on her own - yet nobody bothered to ask if there was anyone who could help look after her.

Bruised and battered, she was taken home by John in his Toyota pick-up truck. He rang. "It's no good, she just collapsed on the toilet," he said. Fortunately, or so we thought, a bed at a rehabilitation centre (an "Inc", naturally) was found. Admission was secured by paying $2,000, on my wife's credit card. This, we hoped, would be covered by Medicare. It was not - because the scheme kicks in only after a minimum three-day stay in hospital. I was advised to hire a lawyer, and did. He explained that Connecticut requires motor insurance companies to provide personal accident cover. This would take care of the bill for the rehabilitation centre.

The first thing to realise about American insurance companies is that they do not like paying out. For example, a New York restaurateur who ran a business close to the twin towers tried claiming for loss of revenue after 11 September. He was turned down because he opened up his kitchen to provide food for rescue workers.

Our insurers' first trick was to offer $5,000 immediately, as "the maximum available". This was a touch naughty; the entitlement was in fact $10,000. Next came the seat belt ruse. "Cover is limited to $5,000 unless the police accident report says you were wearing an approved seat belt," the harsh metallic voice of the insurance claims clerk said. Given that a passer-by had hauled my mother-in-law out of the car, in case it exploded, we were in trouble. Except that my wife insisted on reading the small print of the insurance policy and found that no such clause existed.

Meanwhile, my mother-in-law's rehabilitation had started - and we were soon inundated with urgent messages from the rehabilitation centre, inquiring about payment and what arrangements we had made for discharging my mother-in-law.

By this point, my wife and I had decided to fly to America. There was plenty of work waiting for us when we arrived: the bill for the leg brace, the small matter of getting some money off the insurers, and placating the rehabilitation home.

Given the insurance company's fictitious seat belt clause, we thought it politic to visit the witness who had hauled my mother-in-law out of the car, an electrician of about 35 who lived in a neighbouring town. "She was definitely wearing a seat belt," he said as his wife served us apple pie. "I will write a letter to whoever you want." Then it was off to the police station, where the desk officer talked us through the standard accident report used by the police in Connecticut, which the insurers regarded as so important.

The lawyer - who predicted that his charges would be about $250 - showed us how a routine road accident had generated quite an impressive-looking file, which he warned would thicken in the weeks to come.

My mother-in-law, meanwhile, was back home. We were involved in lengthy discussions with a physical therapist about what she would need. Again, surprise surprise, two-thirds of the conversation revolved around who would pay for what. He was also a lawyer.

I hope that neither my mother-in-law nor we will be bankrupted by the medical bills. But by my crude calculations, the number of people involved in sorting out the paperwork and payment has outnumbered those involved in her care. By December the bills were starting to arrive, but the motor insurers - despite Connecticut's "no fault" system - did not seem very enthusiastic about paying out. It appeared that a "new assessor" had been appointed to deal with the claim. The ambulance service meanwhile had called on the services of debt collectors.

Early on in our voyage of discovery, one of the more sympathetic members of the cast of dozens we encountered said to me: "Of course, you have socialised medicine in Britain."

Yes, we do, and thank God for that.

David Millward is a staff writer for the Daily Telegraph