46 The Ombudsman and the Battle to Make the Health Insurers Obey the Law – Part 7: 10 October 2024

Although written communications from the Ombudsman had been sparse in December 2021, they ceased completely in January 2022.  My complaints to the Ombudsman were treated in the same way as any call made to a call centre – “Your complaint is very important to us and if we can ever be bothered, we might get back to you sometime next year or perhaps the year after”.  This Table summarises my attempts to get someone - anyone - at the Ombudsman to do something - anything - about enforcement of the law relating to the health insurers.  The Ombudsman was not remotely interested.

 

Details	Length of Communication	How Made	Date of Response	Length of Response	What Did Response Say?
(1) Letter dated 12 January 2022 addressed to Sarah de Sade, Complaints Officer	(1) 6 pages, plus claims for payment for Lift services provided on 17 and 23 December 2021, plus copies of correspondence from HCF	Email to Ombudsman@ombudsman.gov.au  sent at 11:53 am on 12 January 2022	Ignored – no reply	Ignored – no reply	Nothing – no reply
(2) Email dated 18 January 2022 addressed to Sarah de Sade, Complaints Officer	(2) 5 lines, plus copy of my letter to HCF dated 18 January 2022 (3 pages)	Email to Ombudsman@ombudsman.gov.au at 12:01 pm on 18 January 2022	Ignored – no reply	Ignored – no reply	Nothing – no reply
(3) Letter dated 25 January 2022 addressed to Sarah de Sade, Complaints Officer	(2) 3 pages, plus copy of my letter to HCF dated 24 January 2022 (5 pages), plus copy of “Sir Humphrey Appleby “Yes Minister” Foundation” certificate awarded to Junita Lindsay	Email to Ombudsman@ombudsman.gov.au sent at 9:44 am on 25 January 2022	Phone call from Sarah De Sade on Friday 28 January 2022.  No written reply - ever	No written reply	No written reply ever Phone call said HCF would make an “offer” to me and that Director of Dispute Resolutions would write to Lift
Phone call from Sarah De Sade received at 9:13 am on Friday 28 January 20223	21 minutes 31 seconds	Phone call from Private Number	I answered the call	21 minutes 31 seconds	Matter was being considered by the Ombudsman

* Email addresses at the Ombudsman always conclude ombudsman.gov.au

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My letter to the Ombudsman dated 12 January 2022 summarised the responses that I had received from HCF up to that date.  On page 5 of this letter, I said this.

Because Margaret still suffers from what is likely to be terminal cancer, she continues to attend Lift to receive medical treatment as recommended by her treating medical practitioners.  Margaret received treatment on 17 December 2021 and we paid Lift directly for the services -$235.00.  I submitted a claim to HCF on 27 December 2021 seeking reimbursement under our policy of health insurance.  I attach for your information, copies of the documents submitted with that claim.  The kindest conclusion I am able to reach is that the relevant HCF staff who “assessed” this paperwork are unable to read.  Lift Cancer Care Services is a registered private hospital and on 17 December 2021 – the date that Margaret received the services which are the subject of the claim – she was admitted as a patient into the hospital.

 

On the final page of the 12 January 2022 letter, I said this.

 

I appreciate that the Office of the Ombudsman prefers where this is possible, to see complaints resolved through a process of direct negotiation between the health insurer and the holder of the health insurance policy, but it is clear to me that in this case, HCF has no intention of resolving the complaints and that it has no intention of actually saying that it has no intention of resolving the complaints.  In the circumstances, it seems to me that HCF is using the normal policy of the Ombudsman as a shield to try and prevent it from acknowledging that it is grossly in the wrong.  I believe that the policy of HCF is to delay resolution until “nature takes its course” and the patient (in this case my wife Margaret) dies.  Once the patient has died, the holder of the health insurance (if it is not the dead patient) will have little energy left to continue pursuing the matter. As I pointed out in my original letter dated 3 December 2021, this is a systemic issue involving multiple cancer patients across multiple States and Territories.  This is very clearly a matter where it is thoroughly appropriate that the Ombudsman take action on behalf of the multitude of other cancer patients who, like Margaret, face the prospect of dying before HCF relents or who perhaps have already died.  HCF is displaying callousness on a level which would bring smiles of satisfaction to health funds such as those which provide “managed care” in the United States. Please take action quickly. My wife Margaret and I look forward to hearing from you.

 

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When I wrote my original letter to the Ombudsman on 3 December 2021, I had been confident that in a matter such as this, the Ombudsman would take speedy and effective action.  By 12 January 2022, I was extremely disappointed but I had not the given up hope that the Ombudsman might eventually do the job Parliament had entrusted to it.

In my email to the Ombudsman dated 18 January 2022, I enclosed a copy of my letter to HCF dated 18 January 2022.

Tit became clear by the end of January 2022 that the Ombudsman had zero interest in doing its job.

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Sarah De Sade finally phoned me at 9:13 am on Friday 28 January 2022.  The call lasted 21 minutes and 31 seconds.  During this call, Sarah De Sade told me she had been on holidays since late December 2021 and she had not asked anyone to look after her work while she was on leave.  She said that senior officers of the Health Department and the Ombudsman had been aware of the “dispute” between Lift and the health insurers for about two years and that a decision on what to do with the Lift complaints would be made at a senior level in the Ombudsman at an unspecified future date.  When Sarah stressed to me that the Ombudsman was a different government agency from the Health Department, I told her that I was already aware that the Ombudsman was a different agency from the Health Department and that I expected the Ombudsman to carry out its statutory duties regardless of any attitude that the Health Department might have about the conduct of the health insurers.

This phone call reinforced my serious doubts about the manner in which the Ombudsman was treating my complaints.

I formed the provisional belief that the Ombudsman and the Australian Health Department were probably corrupt.

My belief that the Ombudsman and the Australian Health Department were corrupt, was reinforced by later events.

I have sent the Ombudsman the link to these blogs.  You never know, a miracle might yet occur and the Ombudsman might yet apologise for its appalling conduct.