Me climbing the bottom of Croagh Patrick 16th of September 2019.
****
View from Louisburgh Ferry, Ireland 16th of September 2019.
****
The purpose of Sheena Jack’s letter of 6th of May 2022 was simple – implement Bulls**t Baffles Brains.
****
This is the first part of my dissection of the letter.
****
You Were Supposed to Go Away
Dear Mr Hankin, Re: Treatment of claims for services provided by Lift Cancer Care Services Thank you for your comprehensive and heartfelt letter. I appreciate you informing me of your frustrating experience with HCF in recent months and of the details of your claims history in relation to Margaret's treatment at Lift Cancer Care Services (Lift). |
Translation ↓ |
You wrote to all company Directors. I did not expect this; you have given me multiple headaches. I have to protect myself from the fallout. How can I shut you up? |
****
You Didn’t Go Away
Firstly, I would like to express my sincerest thoughts of sympathy to you and Margaret for the difficult period you have both faced since Margaret's diagnosis with ampullar cancer in July 2020. This must have been, and would be continuing to be, a very emotional and uncertain experience for both of you, which I understand would not have been made easier from claims rejections and unsatisfactory communication from HCF. |
Translation ↓ |
I must pretend to be sorry for what we did to you and Margaret. Why didn’t you go away? |
****
I Must Pretend We Made a Mistake
I would also like to apologise for the stress HCF may have caused through the communication and correspondence that you have received from us in relation to your claims. It appears that the information you have received from the complaints resolution and customer service teams at HCF has been inconsistent and at times, incorrect, and your experience as a member throughout this complaint process has been below that which we expect and aim to achieve for our members. |
Translation ↓ |
If you had gone away, I wouldn’t have to pretend this has been a mistake. Now I must pretend to be nice while also denying we broke the law by refusing to pay the Lift claims. **** I had nothing to do with what happened. It was all a cock up by the “complaints resolution and customer service teams”. |
****
I Have to Lie (1)
Based on your interactions with HCF to date, I appreciate that you have formed the view that HCF is intentionally banning any claims for hospital benefits that have been made for services provided by Lift. I set out below an explanation of HCF's approach to the claims made by Lift in relation to its provision of services. I hope this explanation provides some clarity for the reasons why we rejected claims submitted by Lift (although as you are aware, we have paid claims on an ex-gratia basis, including reimbursement for claims paid by Margaret, to remove out of pocket costs for members). |
Translation ↓ |
We did ban payment of claims to Lift Cancer Care. That is why we never paid Lift except when our staff disobeyed instructions. I hope to divert you from our illegal actions in “intentionally banning any claims for hospital benefits that have been made for services provided by Lift”. We broke the law but we are really nice. We did you a favour when you complained about us breaking the law. We paid some claims and told you we would not pay any future claims. |
****
I Have to Lie (2)
In relation to your experience in making a complaint to and communicating with HCF, I have set out in this letter how we will respond. |
Translation ↓ |
Now I have to come up with something. |
****
Meaningless, Misleading Words
Reasons for rejecting claims made by Lift As you have described in your letter, Margaret attends Lift to undertake supervised exercise sessions that are appropriate for her physical condition. |
Translation ↓ |
I must give the impression I am saying something although I am really saying nothing. This waffle gives the impression Lift is an ordinary gym and not a registered hospital. |
****
Sheena Jack Comes Up With a Really Big Lie
Reasons for rejecting claims made by Lift … She also receives a medical examination by a doctor prior to commencing this exercise, which would constitute a consultation with a general practitioner and be categorised as MBS* item 37 or 47 (the Type C procedure). * MBS = Medicare Benefits Schedule |
Translation ↓ |
The admission that Margaret’s “medical examination by a doctor prior to commencing this exercise … would constitute a consultation with a general practitioner and be categorised as MBS item 37 or 47” contradicts the claim made by HCF Marion where Rachael Harwood claimed there is no Medicare Item 37. **** By claiming Medicare Items 37 and 47 constitute “the Type C procedure”, Sheena tells Really Big Lie. They are not. The law requires payment by Medicare – not health insurers - of a stipulated fee for listed medical services such as medical examinations. When the patient directly pays the medical practitioner for the examination, Medicare makes the payment to the patient. If the medical practitioner sends a medical examination bill directly to Medicare, the required payment is made to the medical practitioner. **** Payment for any Item 37 or 47 medical examination never involves HCF. It is a matter between Medicare and the patient or Medicare and the doctor. **** Sheena asserts that the medical examination is the “Type C procedure”. This is bulls**t and as HCF CEO, Sheena must have known this. **** A “Type C procedure” is any medical procedure described in clause 7 of Part 3, Schedule 3 of the Private Health Insurance (Benefit Requirements) Rules 2011. **** Any medical procedure which cannot safely be administered outside of a hospital is a Type C procedure, even if hospital admission is not needed for other patients who are not gravely ill. **** A medical procedure is any procedure thought appropriate by a medical practitioner. **** ALL patients who attend Lift have cancer. All been referred to Lift by their treating doctors. Their doctors say none of them can safely receive Lift treatments unless they are in hospital. Margaret was referred to Lift by her radiologist Dr Palumbo. **** No claim was ever made for the cost of the treatments Margaret received from Lift. **** The law says that when a patient is admitted to a hospital, a minimum payment must be paid by the private health insurer to cover the cost of the hospital admission. HCF and other health insurers refused to pay the fee required by law for the admission of cancer patients to a hospital. The health insurers were NEVER asked to pay for the treatments administered while patients were in the hospital. **** Sheena Jack was Chief Executive of HCF. She must have known what she said in this part of her letter was a Really Big Lie. |
I will dissect the rest of Sheena Jack’s letter in the following blogs.
****
No comments:
Post a Comment