69 My Battle to Make the Health Insurers Obey the Law Part 17, Section 2: 24 October 2024
Unpicking the Ombudsman
Letter Dated 29 March 2022
Unpicking That the Ombudsman Knows Lift Tells Patients About the Ombudsman
What an extraordinary
sentence. Of course, Lift told its
patients that they had a right to complain to the Ombudsman. Parliament gave the patients that right under
the Ombudsman Act. Did the Ombudsman
think this was a guilty secret which needed to be exposed? Explaining the legal rights given to all is a
basic feature underpinning all countries that are ruled by law.
Unpicking the
Reluctant Acceptance by the Ombudsman that Patients Had the Legal Right to Complain
to Ombudsman
This is where the Ombudsman begins to
spell out what it really wants.
This piece of bureaucratic bullshit means
this –
Because the
Ombudsman Act gives us no option, we will continue to formally accept
complaints from people asserting that their health insurers refuse to obey the
law. We will also continue to refuse to
enforce the law and all complaints will be treated in the same contemptuous
manner as all complaints made to us so far.
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Unpicking Ombudsman Letter – “Cease and Desist” or Else!
****
I
spent many years in the legal profession and saw many surprising things. I never encountered a letter with demands
such as this.
I
will break this paragraph into “bite size portions” to help digest what it is really
saying. Bear in mind that this letter
came from one of the two official government agencies with the official job of
enforcing the law in the area of private health insurance.
This
is more readable and this is what the Ombudsman was actually saying.
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We have known since before February
2020 that the health insurers have been refusing to pay for treatments
provided by Lift. |
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↓ |
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Even though we are one of the
designated regulators of private health insurers, we at the Ombudsman refuse
to enforce the law. |
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↓ |
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Because we the Ombudsman refuses to
enforce the law, you have to enforce the law yourself. |
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↓ |
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Even though we the Ombudsman know that
the health insurers have refused to obey the law since before February 2020,
you should try and persuade the health insurers to obey the law. |
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↓ |
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Even though the health insurers are
highly likely to continue to refuse to obey the law, do not tell your
patients they have a right to complain to the Ombudsman – we do not want to
deal with any more complaints. |
****
This
sentence deserves special attention..
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Further,
with respect to informed financial consent,
we expect the hospital to advise patients about any costs for which they may
be liable prior to the commencement of treatment, to mitigate any risk of
patients receiving unexpected bills afterwards. |
In
the email I got from Junita Lindsay on 21 January 2022, HCF offered a “resolution”
of my complaints which involved a one off payment. That offer was subject to me agreeing to
provide HCF with “Confirmation in writing that Lift
Cancer Care Services did not provide a list of estimated costs” before Margaret
had her treatments
In the final
sentence of this fifth paragraph of its letter, the Ombudsman – officially a regulator
but in reality a mouthpiece for the health insurers – attempted to revive the total
lie that Lift had misled its patients about cost.
In effect, the Ombudsman said in this part of its letter that
if Lift suffered any financial hardship because the health insurers refused to
obey the law, Lift had inflicted that hardship on itself – presumably, patients
should be told that the health insurers refused to obey the law!
****
Unpicking the Breathtaking
Hypocrisy of the Ombudsman
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We understand the Department of Health contacted you previously to provide information
about the operation of Type C Certificates. We suggest you continue to liaise
with the Department about this matter, ideally with a view to obtaining its
advice about the relative merits of the positions held by your facility and
the various private health insurers regarding payment for these claimable
Type C services. |
This final paragraph of
the Ombudsman letter is breathtaking in its “go away, don’t bother us”
hypocrisy.
****
The Type C Certificates
provided by Lift to the health insurers mirrored the wording suggested by the
Health Department – and the health insurers continued to refuse to obey the
law.
The Health Department
was aware that the Certificates followed the wording suggested by the Health Department.
The Health Department
was well aware that the health insurers refused to obey the law.
Despite knowing all
relevant facts, the Health Department - like the Ombudsman - ignored what was
going on.
The Ombudsman
was well aware that the Health Department knew all the relevant facts and the
Ombudsman knew the Health Department refused to do anything. When the Ombudsman suggested Lift seek help
from the Health Department, it already knew no help would be provided by the
Health Department.
****
Unpicking the Ombudsman Letter – Don’t Bother Us Again
(1)
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If you wish to discuss this matter
further, please contact Elle Starbuck via email |
The person nominated as
the contact to discuss the Ombudsman letter was not the person who signed the
letter. The only way in which any
“discussion” could take place was by email addressed not to the signer of the letter
but to a different person – someone whose position in the Ombudsman was left
unidentified.
****
Unpicking the Ombudsman Letter – Don’t
Bother Us Again (2)
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Kind
regards [Illegible
Signature] Emma
Cotterill Senior
Assistant Ombudsman Industry
Branch |
The sign off at the end of the
letter was also breathtaking in its hypocrisy.
Having comprehensively insulted
and attempted to demean Lauren Whiting, Chief Executive of Lift, Emma Cotterill
actually said “Kind regards”. This gave
me a clear image of someone smirking while sticking two contemptuous fingers in
the air.
The ludicrously insincere “Kind
regards” came from a woman with a very important sounding title.
Emma Cotterill was “Senior
Assistant Ombudsman, Industry Branch”.
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