Plainfield man faces insurance woes, rising bills after out-of-state accident

Tabatha Ortega of Plainfield got the call that her son had been “in a real bad accident” at 6 a.m. Valentine’s Day, she said.

Anthony Ortega, 23, had gone down to Texas to visit relatives. A friend of his cousin’s gave him a ride home in a snowstorm, Tabatha said.

“They hit some black ice and the truck they were in rolled several times,” Tabatha said. “And he broke his back in two spots. It’s definitely been a nightmare.”

If that wasn’t bad enough, the driver didn’t have auto insurance, Tabatha said.

“You don’t think to ask, ‘Do you have insurance?’ before you get into someone’s car,” Tabatha said. “Luckily, we had health insurance.”

But the family’s HMO plan would not cover the ambulance ride or the first hospital where Anthony had care, because that hospital did not have a full emergency room, she said.

The insurance only covered inpatient services at the second hospital where Anthony had metal rods and screws placed into his back, Tabatha said.

Insurance also did not cover any outpatient services or a trip to the emergency room when Anthony had later trouble breathing, Tabatha said.

Many of these issues arose because the accident happened out of state and, hence, out of network, Tabatha said. She estimates their out-of-pocket medical costs so far are $9,000.

The main concern when Tabatha received the call was bruising in Anthony’s lungs.

“That can go from good to bad really fast,” Tabatha said. “They had suggested we get there right away.”

Tabatha said she and Arturo were able to book a 9 a.m. flight, the last flight to Texas that day because of the inclement weather there, she said.

“When we got here, we stayed at a hotel a couple blocks from the hospital,” Tabatha said. “But we ate gas station food because everything was closed.”

Fortunately, Anthony’s prognosis was better than doctors initially thought, Tabatha said.

“They didn’t even think he would be able to talk when this first happened,” Tabatha said. “He’s actually up and moving.”

Tabatha said they eventually moved to a relative’s house where Anthony started having physical therapy three times a week after the hospital discharged him. He’s able to walk short distances and his pain is tolerable, she said.

But it’s still uncomfortable to stand or sit and he’s most comfortable when lying flat, Tabatha said.

“He’ll make a full recovery,” Tabatha said. “But he’ll always have problems with his back. He’s a roofer and they’re saying right now that he’ll be off work for at least a year…due to the type of surgery he had on his back.”

The couple has three other boys, ages 16, 19 and 21, and two 11-year-old twin girls. At one point, Arturo went back to Plainfield to bring the twins back to Texas so they could continue their remote learning there, Tabatha said.

Anthony was supposed to fly back to Chicago on Monday morning, where Arturo would pick him up. But wintry weather in Illinois delayed that trip, she said.

“The girls and I will be driving back tomorrow,” Tabatha said on Monday.

But once he is back in Plainfield, he will meet with is primary care physician, who will coordinate his physical therapy, Tabatha said.

To donate to the “Helping Anthony Ortega With Medical Expenses” GoFundMe account, visit bit.ly/30LmuKT.