Margaret was dying in March 2022, but I refused to let the health insurers continue to ignore the law and the deaths of Lift Cancer patients.
The health insurers were engaged in a criminal scam.
The Commonwealth Ombudsman knew about the scam and did all it could to help the health insurers.
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Margaret had her 60th birthday on 29 March 2010.
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These emus were at Wilpena Pound on 25 March 2015. We were there with Anne Ryan and Nes Fernandez. Anne terminated her affair with Nes after she persuaded him to stop bushwalking.
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Margaret and the Cancer
The mystery of Margaret’s good health despite her deadly cancer continued throughout March 2022; we still lived in God’s Pocket.
Margaret had a cat scan on Friday 4 March 2022 and it identified the cancer as an irregular mass in the ampulla. The cancer was 24 millimetres in diameter. Inexplicably, the cancer had not grown.
The oncologist scheduled Margaret’s next cat scan for June 2022. While the cancer was “sleeping”, there was no reason for alarm.
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Immunotherapy
During the operation on 3 December 2021, the surgeon had extracted a tissue sample and forwarded it for testing by a pathology laboratory in Victoria. On 22 March 2022, the laboratory advised the oncologist that it was about to “commence processing the sample for sequencing”. Our hope was that the tissue sample test would tell us that Margaret was a suitable candidate for Immunotherapy. Immunotherapy is a treatment method that enables the body to recognise cancer cells as “bad guys”. Once it recognises “bad guys”, the immune system vigorously attacks foreign cells.
Cancer is the result of the uncontrolled growth of the body’s own cells. This means the immune system cannot usually recognise cancer cells as “bad guys” and therefore leaves the cancer cells alone. This means the cancer can grow without being attacked by the immune system.
This is one reason why cancer is often able to kill its victims. The immune system ignores the cancer so it grows unhindered by the immune system.
Our hopes for an alternative treatment option through immunotherapy disappeared when the oncologist received another email from the laboratory on 29 March. It said “Insufficient specimen for analysis. Test not performed.” Additional tissue sample material could only be obtained through another operation. For the time being at least, immunotherapy was not an option.
Margaret and Lift Cancer Care Services
Margaret had exercise therapy treatments on three occasions during March 2022. This Table summarises the claims lodged with HCF and what HCF did with them. Our claims were treated with contempt by HCF.
* Emailed on 4 April 2022 to Junita Lindsay at HCF with Letter dated 4 April 2022
** Emailed on 25 April 2022 to Junita Lindsay at HCF with Letter dated 25 April 2022
*** Emailed on 25 April 2022 to Junita Lindsay at HCF with Letter dated 25 April 2022
Every one of the claims we made for Lift treatments provided to Margaret during March 2022 was ignored by HCF. The last time I checked, they still did not exist according to our online official HCF claims history record.
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Margaret and I attended a cancer patients’ support meeting at Lift on Sunday 6 March 2022. At the meeting, Lift patients outlined their experiences in trying to get their health insurers to pay for the treatments provided by Lift Cancer Care.
Everyone at the meeting had similar experiences to recount. One very common experience was that the insurer demanded additional information but never identified what additional information they claimed to need
The most common experience was the one we experienced. The insurers completely ignored the claims. Everyone at the meeting found it was impossible to obtain any information from the insurers on why their claims for Lift treatments were ignored.
Many patients at the meeting had made formal complaints to the Ombudsman about their health insurers. No one at the meeting said dealing with the Ombudsman had been a positive experience. Every patient at the meeting recounted how the Ombudsman ALWAYS dismissed complaints - and usually did so for obviously false reasons. The Ombudsman had dismissed complaints for these reasons.
If Lift Cancer Care Services had been refused payment – which happened when the patient paid the “gap” fee when given the treatment (the difference between the insurance amount the insurers was required by law to pay and the amount actually paid by the patient) - the Ombudsman dismissed the complaint saying the patient had suffered no financial loss. As far as the Ombudsman was concerned, if Lift Cancer Care rather than the patient was cheated by the health insurers, that meant the Ombudsman was entitled to dismiss the complaint!
Sometimes the insurers sometimes paid what they called an “ex gratia” payment for the amount that should have been paid as at the date of the claim. Whenever the insurers did this, the Ombudsman routinely dismissed the complaints, refused to do any investigation and refused to accept any further complaints for unpaid treatments by Lift Cancer Care.
Patients at the meeting were insured by three separate health insurers - HCF, NIB and Teachers’ Health. The actions described in relation to all three funds were so similar that they must have been coordinated.
Because of the similarity in how they handled claims and complaints, it was probable the three insurers were all acting in accordance with legal advice from the same legal firm. Those at the meeting had experienced these responses from their health insurers:
A denial that any claim had been made;
An assertion the health insurer would not pay for outpatient service even though the insurer was well aware the treatments were not outpatient treatments;
An assertion that if the patient provided further information, the insurer would reconsider – but no additional information was ever identified as being needed to reassess the claim; and
When a patient tried to physically lodge a claim at the premises of the insurer, the patient was told the claim could not be submitted for assessment because the computer system would not permit it.
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The health insurers were obviously engaged in an illegal scam to avoid the obligations imposed on them by law.
The Commonwealth Ombudsman was obviously a part to the illegal scam operated by the health insurers because it was providing cover for the insurers instead of doing the job Parliament had told it to do.
I was disgusted. The wonderful people at the meeting might die because of what the insurers were doing – and the Ombudsman thought this was a good thing.
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