44 The Battle to Make the Health Insurers Obey the Law – Part 5: 9 October 2024
This Table summarises the correspondence I sent to HCF on 12 January 2022 and the “responses” from HCF. in January. During January, it became increasingly clear that HCF intended to do nothing at all except get rid of me at the lowest possible financial cost.
****
On 21 January, HCF attempted to “buy me off” by offering to pay for Lift services up to that point because its payments made in “error” had created “an expectation” that Lift services were covered. The clear intent of the email was that once I had received this “voluntary” payment from HCF, HCF would continue to refuse to pay for services provided by Lift Cancer Care Services. This email offered no explanation as to why HCF claimed that the Lift services were not covered.
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|
Communication
Details |
Length of Communication |
How Sent |
Date of Response |
Length of Response |
What Did Response
Say? |
|
Letter dated 12 January
2022 addressed to Junita Lindsay, Complaints Resolution Officer |
5 pages, plus claims for
payment for Lift services provided on 23 December 2021 and 7 January 2022 |
Email to jlindsay@hcf.com.au sent at 10:19 am on 12 January 2022 |
(1) Email received at 9:58
am on Tuesday 18 January 2022 from Junita Lindsay, Complaint Resolution
Officer (2) Email received at 5:11
pm on Friday 21 January 2022 from Junita Lindsay, Complaint Resolution
Officer |
(1) 11 lines plus “sign
off” (2) 11 lines plus “sign
off” |
(1) “We understand you
have referenced a letter dated 6 January 2022 which had advised that we were
not able to assess a recent claim. We
do want to clarify that this was an automatically generated letter in
response to the claim submitted and is not HCF ‘s formal response to the
concerns raised with the … Ombudsman” (2) Because HCF had
“erroneously” paid some Lift claims in the past, HCF would make an “ex
gratia” payment if we confirmed in writing that Lift did not warn us about
estimated costs of service |
|
Claim documents seeking
payment for Margaret’s Lift treatment provided on 23 December 2021 |
3 pages |
Attached to email to jlindsay@hcf.com.au sent at 10:19 am on 12 January 2022 |
No response - ever |
Zero length |
No response - ever |
|
Claim documents seeking
payment for Margaret’s Lift treatment provided on 7 January 2022 |
3 pages |
Attached to email to jlindsay@hcf.com.au sent at 10:19 am on 12 January 2022 |
No response - ever |
Zero length |
No response - ever |
|
Letter dated 24 January
2022 addressed to Junita Lindsay, Complaints Resolution Officer |
5 pages |
Email to jlindsay@hcf.com.au sent at 3:45 pm on 24 January 2022 |
No response - ever |
Zero length |
No response, ever |
|
” Sir Humphry Appleby
“Yes Minister” Gold Medal Award Certificate with dates 18 January and 21
January 2022 |
1 page |
Attached to email to jlindsay@hcf.com.au sent at 3:45 pm on 24 January 2022 |
No response - ever |
Zero length |
No response - ever |
Apart from this, the
“resolution” proposed by HCF was inherently deceitful. The HCF “resolution” did NOT contemplate in any way that HCF would pay the unpaid portion of
the Lift accounts which had already been submitted to HCF by Lift. Instead of paying the Lift invoices, HCF clearly
contemplated it would pay only the “gap” payments we had already paid to
Lift. There was no suggestion that it
would pay the balance of the outstanding Lift invoices. I believe this was clearly implied in the
email from Junita Lindsay.
But before HCF would
pay even this miserable amount of money, it demanded that we lie about our
dealings with Lift Cancer Care Services.
****
The relevant part of the email said this.
|
We do believe
we have a resolution which includes looking at reimbursing the costs of
claims since we had begun paying the claims on 6 January 2021. We acknowledge
that HCF had paid claims received from Lift Cancer Care and while this was in
error, it is understandable that an expectation had been set that these
services would be covered. The resolution we are aiming to proceed with is on
the basis that you were not made aware that the fees would be payable by
yourself should they not be claimable through HCF. To proceed with
gaining approval to provide this resolution, we request the following: ·
Confirmation from yourself in writing that Lift
Cancer Care Services did not provide a list of estimated costs before
participating in the program ·
Invoices of payments made to Lift Cancer Care
for the services received |
****
HCF wanted copies of
our receipts for our “gap” payments so that it could calculate the total amount
of our “gap” payments and pay that amount to us – a total of about $820.00 on
21 January 2022.
I believe HCF
intended that Lift Cancer Care Services would receive no payment at all for the
invoices already submitted to it by Lift.
Those invoices for Margaret amounted to a total of $6,978.00 as at 1
December 2021.
In order to get this miserable amount of money –
and say goodbye forever to any hope of persuading HCF to obey the law in
future - HCF demanded that we lie about the conduct of Lift Cancer Care
Services.
The demand to confirm that Lift “did
not provide a list of estimated costs before participating in the program”
would have required us to lie. We had never suggested any such thing.
I believe HCF wanted us to lie as a means to try and destroy Lift.
The proposed
“resolution” in the email dated 21 January 2022 was putrid.
I believe HCF acted
knew Margaret had a deadly cancer, expected the cancer to kill her, and
that when Margaret died, I would stop annoying HCF.
I believe HCF
attempted to use raw power to smash someone it believed had zero power.
****
HCF completely ignored
its Complaint Management
Policy.
|
HCF’s complaint handling process is intended to
be fair and equitable to all parties. It allows for active involvement by
complainants as far as practicable, permitting their views to be heard and
taken into account in a balanced, respectful and meaningful way. |
****
|
We will acknowledge complaints promptly and
respond in full in a reasonable timeframe taking into account the urgency of
issues raised. We will communicate expected timeframes to you and inform you
if we think there may be some delay. |
****
|
We will be helpful, courteous and professional
in all our dealings. We will explain the reasons for our decision and
any remedy or resolution we consider fair and reasonable in the circumstances. |
The central issue in my complaint was that HCF was
breaking the law.
Instead of explaining why it actions were lawful,
HCF tried to shut us up by paying $820.00 and ignoring my belief that its conduct
was unlawful.
I believe HCF was well aware it conduct was unlawful.
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