Blog No. 152 - Keeping Margaret Alive, Part 3: 20 January 2025

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.

****

Margaret had her 60th birthday on 29 March 2010.

****

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.

****

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.

****

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.

Date of Clam (March 2022)	Claim Paid or Unpaid?	Notification to Us?
3 March*	Unpaid	No
16 March**	Unpaid	No
25 March***	Unpaid	No

* 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.

****

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.

****

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.

 151 –Keeping Margaret Alive, Part 2: 19 January 2025

We visited Granite Island on Sunday 17 February 2019.  It is very pretty, but it is in fact a rock covered by a thin layer of soil – so it is barren.

By February 2022, my heart felt as barren as Granite Island and as barren as the sea surrounding it.

Margaret was dying and the health insurers had zero interest in obeying the law and zero interest in helping cancer patients live.

****

This is a sea view from Granite Island taken on Sunday 17 February 2019.

****

Throughout February 2021, our health insurer HCF continued to completely ignore all claims we lodged for treatments given to Margaret by Lift Cancer Care Services.

To prevent the Ombudsman from dismissing our complaints about HCF on the ground the loss had not been suffered by us but by Lift Cancer Care, I made Lift give us an invoice for $6,978.00 and I then paid it.  

This made no difference to the conduct of HCF or the conduct of the Ombudsman.  HCF and the Ombudsman continued to ignore the law.

****

In previous blogs, I have already recounted details of my unrelenting battle to force the health insurers to obey the law.  There is no need for me to repeat that story here.

****

Although she had been so close to death at the start of December 2021, Margaret remained in relatively good health after I got her home on 3 December 2021 and she received three treatments from Lift Cancer Care in January 2022.  This Table summarises the Lift claims we lodged with HCF and what HCF did with them.  

As part of the scam it has been able to get away with, and with what must have been the approval of the Australian Health Department and the Commonwealth Ombudsman, HCF simply pretended the claims never existed.

Date of Clam (January 2022)	Claim Paid or Unpaid?	Notification to Us?
7 January*	No	No
18 January**	No	No
25 January***	No	No

* Emailed on 22 February 2022 to Junita Lindsay at HCF with Letter dated 12 January 2022

** Emailed on 4 February 2022 to Junita Lindsay at HCF with Letter dated 4 February 2022

*** Emailed on 12 February 2022 to Junita Lindsay at HCF with Letter dated 12 February 2022

I emailed claims for these treatments to Junita Lindsay, Complaint Resolution Officer at HCF.  Junita had told me she was “investigating” the complaints I had made to HCF in my letter dated 3 December 2021.  We both knew this was a complete lie.

Each of these claims was ignored by HCF.  In January 2025, three years after they were lodged with HCF – and even though they have now been paid because of the extreme pressure I placed on HCF – these claims still have no existence on my HCF claims history record.

****

I had a phone conversation with Sarah De Sade from the Ombudsman in the morning of Friday 18 February 2022.  During this phone call, it became clear to me that the Ombudsman intended to dismiss our multiple complaints on the spurious ground that most of our HCF claims did not cause any financial loss to us because the loss had been suffered by Lift Cancer Care Services.  I was determined to eliminate this as a reason why the Ombudsman might try and dismiss our complaints.

****

Immediately after the call from Sarah De Sade, I rang Lauren Whiting, Chief Executive of Lift Cancer Care Services, and asked her to give us an invoice for all of the Lift treatments for which Lift had not been paid by HCF.  Lauren was very reluctant to do this.  She said Margaret and I ought not be required to remedy the refusal of HCF to obey the law. 

I insisted that we be sent an invoice for the unpaid treatments.

The invoice from Lift Cancer Care Services is dated 18 February 2022.  It lists the dates of all treatments for which HCF had refused payment, plus the unpaid balances of those treatments.  The 18 February 2022 invoice came to $6,978.00 and I paid the $6,978.00 to Lift Cancer Care Services on Sunday 20 February 2022.

****

Inexplicably, Margaret's relatively good health continued throughout February 2022.  We continued occupying that extraordinarily safe place labelled God’s Pocket.  Although I suspected this could not last, I ignored the probability the cancer would return and I would lose Margaret.

Margaret was much smarter than me.  She knew this cancer remission could not last forever.  She loved me, so she did not tell me what she knew.

****

Margaret had three treatments at Lift Cancer Care in February 2022.  This Table summarises the claims lodged with HCF and what HCF did with them.

Date of Clam (February 2022)	Claim Paid or Unpaid?	Notification to Us?
2 February*	No	No
10 February**	No	No
23 February***	No	No

* Emailed on 24 February 2022 to Junita Lindsay at HCF with Letter dated 24 February 2022

** Emailed on 10 March 2022 to Junita Lindsay at HCF with Letter dated 10 March 2022

*** Emailed on 19 March 2022 to Junita Lindsay at HCF with Letter dated 19 March 2022

Each of the claims for Lift services given to Margaret in February 2022 was ignored by HCF.  They have now been paid, but they still do not exist on our HCF claims history record.

****

I did not know it in February 2022, but Margaret’s continued survival despite the cancer, depended NOT on winning the struggle with the health insurers, but on the indefinite continuation of the struggle with the health insurers.

Winning the battle with the health insurers meant Margaret’s cancer remission would cease and the cancer would resume its march towards Margaret’s death.

 

150 –Keeping Margaret Alive, Part 1: 18 January 2025

Our health insurer HCF completely ignored the government approval of Lift Cancer Care Services as a hospital.

HCF had its own list of the hospitals it would recognise.

If HCF did not “recognise” a hospital, HCF ignored claims for services provided by that hospital.

The health insurers were contemptible bastards, as were the Australian Health Department and the Commonwealth Ombudsman who permitted them to ignore the law

****

This photo shows was our complete list of guests on Christmas Day 25 December 2021.  The Cancellation Crew rigidly enforced our exclusion from “civilised” society. 

Margaret was dying but she deserved no sympathy because she had married me.

****

In previous blogs, I have already recounted details of my unrelenting battle to force the health insurers to obey the law.  There is no need for me to repeat that story.

****

Although she had been so close to death at the start of December 2021, Margaret did receive two treatment from Lift Cancer Care in December 2021.  This Table tells the story of the contempt displayed by HCF when I claimed these treatments under our health insurance.

Date of Clam (December 2021)	Claim Paid or Unpaid?	Notification to Us?
17 December*	No	Yes
23 December**	No	No

* Submitted through the HCF online portal on 27 December 2021

** Submitted through the HCF online portal on 7 January 2022 and also by letter dated 27 January 2022 to Junita Lindsay, HCF Complaint Resolution Officer

****

The claim for Margaret’s Lift treatment on 17 December was remarkable only because it was one of the very few Lift Cancer Care claims where HCF actually told us it had rejected the claim.  A HCF letter dated 6 January 2022 said this.

 

Dear Mr Hankin Thank you for your recent claim. We wish to advise a gap benefit for medical services are [sic] payable only when associated with treatment as a hospital in-patient. As the services presented were not provided during a period of hospitalisation, we regret there is no benefit payable. Should you require further assistance with your membership please do hesitate to contact our Member Information line on 13 13 34. Your sincerely The HCF Team

 

****

When you run a business as large as HCF, mistakes are inevitable and sending this letter had obviously been a mistake because it did not obey the HCF order that all claims for treatments by Lift Cancer Care were to be completely ignored – they were not to be registered in the system in any way, they were not to be rejected and they were not to be accepted.

HCF did not think it was a mistake to reject the claim even though the law undoubtedly required it to pay the claim.  From the HCF perspective, the mistake was that HCF had told me in writing that it had rejected the claim and put forward a clearly invented reason for the rejection.

HCF never made this mistake again.  A warning must have been given to the employee who sent the letter. 

The HCF policy was to make sure that Lift Cancer Care claims “disappeared”.  If claims for Lift treatments were officially rejected, then at least in theory, HCF might be required by the Health Department and/ or the Ombudsman to set out the legal justification for the rejection.  Because there was no lawful reason to reject the claims, HCF could not give any legal justification for the rejections.

In practice, HCF had no real need for concern when claims were actually rejected.  Neither the Health Department nor the Ombudsman had any interest in doing the jobs that they were supposed to do.

Legally speaking, the best way for HCF to ignore the law was to make claims for treatments by Lift Cancer Care – and probably claims for treatments by other health providers as well – simply “disappear”. 

If claims “disappeared”, the cancer patient getting the treatment from Lift Cancer Care might forget having ever made the claim.  Legally speaking, this also gave an obvious legal advantage to HCF.  If by some fluke the Health Department or the Ombudsman asked why a claim had not been paid, HCF could simply claim it had no record of the claim – “What claim?  We never got any such claim!”

Legally speaking, the claimed reason for rejection of the claim for Margaret’s treatment on 17 December 2021 was complete rubbish. 

To the knowledge of HCF, Lift Cancer Care Services was an officially approved hospital and Margaret had received her treatment while she was an “in-patient” at the hospital called Lift Cancer Care Services. 

The HCF letter mistakenly sent to us in fact revealed the real reason why HCF had been refusing to pay the claims for Lift treatments.

****

HCF had decided to completely ignore the government approval of Lift as a hospital.  HCF had decided it and not the government would decide whether health service providers would be recognised as hospitals.  If HCF did not “recognise” the hospital as a hospital, HCF would ignore the legal rules that required it to pay claims for services provided by that hospital.

****

I have no doubt in my mind that the decision makers at HCF responsible for the disgusting treatment of claims made for treatments provided by Lift Cancer Care Services committed a large array of crimes.

To this day, neither the Australian Health Department nor the Commonwealth Ombudsman have shown the slightest interest in investigating these crimes.

I draw the inevitable conclusion that the crimes committed by HCF were committed with the knowledge and agreement of the Australian Health Department and the Commonwealth Ombudsman.

 149 – I Learn How to Keep Margaret Alive, Part 2: 17 January 2025

Early in the afternoon ofn 3 December 2021 I demanded that the health insurers obey the law.

By 7.30 pm on that day, Margaret’s cancer had retreated and her stents were removed.

I knew then that if I wanted Margaret to live, I had to force the health insurers to obey the law.

I was determined to enable Margaret to live.

Margaret and me on 26 March 2015 at Wilpena Pound, South Australia.

****

As recounted in Blog 148, Margaret rang me at about 7:30 pm when she woke after her operation.  She had spoken to the surgeon and the surgeon had told her she could go home.  In the two days between the previous operation on 1 December and the latest operation on 3 December, the cancer had shrunk to the smallest size that the surgeon had ever seen it.  The cancer was not gone, but it had shrunk – and it had done this without any further treatment in the two days between 1 and 3 December.  The surgeon could not explain what had happened.  The surgeon told Margaret that unless she experienced cancer symptoms, he would not schedule another “look see” operation until one year later - December 2022.

The written report from the surgeon said this.

EUS Findings 1 As previous EUS, there was a nodal mass on the left of the celiac axis, measured up to 20 mm.  The lesion looked malignant and as requested, the lesion was biopsied using EUS FNA technique.  One pass of 25 G needle were performed for histology. 2 There was a cyst in the pancreatic head/ neck region.  The cyst looked benign and had no malignant features.  The ampulla was thickened and was hard on FNA.  One pass of 25 G FNA was performed to check for presence of carcinoma. 3 The main PD was 2.5 com in size. 4 The liver was also screened careful[ly] for mass lesion but no definite lesion can be seen in the visualises portion. 5 BBD stents had decompressed the biliary tract EUS Interventions FNA was performed

EUS = Endoscopic Ultrasound

FNA = Fine Needle Aspiration

PD = Pancreatic Duct

BBD stents = Benign Biliary Disease stents

The report says the stents had “decompressed the biliary duct”.  In plain English, this means the stents had restored the Margaret’s biliary to normal functioning.  On 1 December 2021, the biliary tract had been so blocked by the cancer that it could not function at all without the stents to keep it free of blockage by the cancer.  On 3 December the cancer had shrunk so much that Margaret’s bile duct had returned to its normal size and was functioning normally.  Something the surgeon does not mention in this report is that the cancer had shrunk so much that the surgeon removed the two stents in the bile duct because they were no longer needed!

I was torn between overwhelming joy and overwhelming shock as I left home to go to the hospital to bring Margaret home. 

On the Wednesday, Margaret had been on the verge of death.  She was being kept alive by two stents that allowed her bile duct to continue working.

Two days later on 3 December, the cancer had retreated so much that the surgeon removed the two stents from her bile duct.  The stents were no longer needed to keep Margaret alive.  It took days for me to properly digest what had happened.  As I wrote these words more than two years later, I am still stunned by what happened.

****

At 12.51 pm on 3 December 2021, I emailed the first of what became a flood of letters to HCF demanding that it obey the law. 

At 12:54 pm on 3 December, I emailed the first of a separate long series of letters to the Commonwealth Ombudsman demanding that it force HCF to obey the law.

By 7:30 pm on 3 December, Margaret was granted a reprieve from death that we had prayed for, but never dared imagine might ever happen.

Without realising it, I had begun an unremitting struggle to force HCF to obey the law. 

I was so naïve on 3 December 2021 that I did not imagine for a moment that the Australian Health Department, which is supposedly the primary regulator of health insurers, knew exactly what the health insurers were doing and had decided to ignore their refusal to obey the law.

I was so naïve on 3 December 2021 that I did not imagine for a moment that the Commonwealth Ombudsman, which is supposedly the back up regulator of health insurers, also knew exactly what the health insurers were doing and had also decided to ignore their refusal to obey the law.

I was so naïve on 3 December 2021 that I did not imagine that the health insurers had intimate knowledge of the refusal of the regulators to do their jobs and that they knew they could ignore the law without any consequences from the regulators.

                                                                       ****

Once I realised the significance of what had happened, it was impossible for me to stop struggling to force the health insurers to obey the law.  Letting the health insurers continue to break the law could never happen. 

If I let HCF and the other health insurers continue to be contemptuous of the law, Margaret’s cancer would return and she would die.

****

When I eventually won the battle with the health insurers many months later, Margaret was still alive.  This - not the surrender of the health insurers – was what filled me with joy. 

I was of course thrilled by the mean spirited surrender of the health insurers and the ending of the efforts of the health insurers to crush Lift Cancer Care Services, but the elation from this surrender paled beside the continued life granted to my wife.

 

148 – I Learn How to Keep Margaret Alive: 16 January 2025

I learned on 3 December 2021 how to keep Margaret alive.

To keep Margaret alive, I only needed to force the health insurers to obey the law.

No matter what happened after then, I knew I would make the health insurers obey the law.

Margaret and me on 19 November 2020 at Loveon Cafe.

****

In Blog 39, I wrote this.

Throughout Friday 3 December 2021, I worked frantically on letters of complaint to our health insurer HCF and to the Commonwealth Ombudsman.  In theory, the Ombudsman was the government agency which, in conjunction with the Australian Health Department, enforced the laws governing private health insurance. At about 4.30 in the afternoon, I emailed this letter of complaint to HCF.

****

I have now had the opportunity to check my records of that frantic day of work and worry.  The computer tells me that at 12.51 pm on 3 December 2021, I sent an email to HCF.  The following documents were attached to that email.

·         Letter of complaint to HCF dated 3 December 2021 about the refusal of HCF to pay claims for treatments provide to Margaret by Lift Cancer Care Services.

·         Copy of letter of complaint dated 3 December 2021 sent to the Commonwealth Ombudsman on 3 December 2021.

·         Table 1: Itemisation of 32 Separate complaints by Margaret Redden Re HCF.

·         Table 2: Itemisation of Claims Accepted by HCF.

The computer also tells me that at 12.54 pm on Friday 3 December 2021, I sent an email to the Commonwealth Ombudsman.  Attached the email to the Commonwealth Ombudsman were the same documents that I had sent to HCF:

·         Letter of complaint to Commonwealth Ombudsman dated 3 December 2021 about the refusal of HCF to pay claims for treatments provide to Margaret by Lift Cancer Care Services.

·         Copy of letter of complaint dated 3 December 2021 sent to HCF on 3 December 2021.

·         Table 1: Itemisation of 32 Separate complaints by Margaret Redden Re HCF.

·         Table 2: Itemisation of Claims Accepted by HCF.

****

I had been awake since 3.00 am on the day before Margaret’s operation on 3 December. 

I had also been awake since 3.00 am on the day of the operation.

I was physically and mentally exhausted.  I was worried sick about Margaret’s upcoming death.  Like Margaret, I expected the operation scheduled for the evening of that day would simply confirm what the surgeon had already told Margaret after the operation on the 1^st of December – Margaret’s cancer was thriving, Margaret was dying and Margaret would be dead in the near future.

I typed the Tables I sent with my letters of complaint in the morning of Friday 3 December before I wrote the letters themselves.  I needed to know the detail of exactly what had happened.  Had HCF refused to pay all of the claims or only some of them?  Had HCF explained why it had refused to pay the claims?

Back then in December 2021, I was reluctant to make any assumptions of illegality.  My starting point was that surely HCF would never intentionally disobey the law.  This meant the refusal to pay the Lift Cancer Care claims must have been the result of a misunderstanding.  It was weeks before I realised that HCF had not made some innocent mistake.  It was weeks before I realised that HCF did not give a flying fart about what the law required it to do.

It was months before I realised that the government enforcement agency – the Commonwealth Ombudsman – knew exactly what HCF had been doing and had made a decision to refuse taking any action to enforce the law.

****

On 3 December 2021, I was naïve.

My wife was dying.

I knew other patients of Lift Cancer Care Services were grievously ill.

I knew HCF, NIB and Teachers’ Health were refusing to pay what the law required them to pay for treatments provided by Lift Cancer Care.

I thought the refusal of the three health insurers to pay for the Lift services must have been the result of some simple mistake.

Once I pointed out that the health insurers had made a mistake, the health insurers would promptly fix the mistake – and if they did not fix the mistake, the Commonwealth Ombudsman would force them to fix the mistake.

****

The surgeon was commencing his list of operations at 6.00 pm that evening.  Margaret did not know where she was on the list.  If she was first, her operation would happen shortly after 6.00 pm and she would be awakened no earlier than about 30 minutes after the operation finished.  If she was further down the operations list, it would be later in the evening before she was awakened.

Once the operation was finished, Margaret would be taken back to the ward and the surgeon would visit when he had finished his list of operations.  Margaret would ring me only after the surgeon had seen her and told her what he had found during the operation.

I expected Margaret to ring me no earlier than 8.00 pm.  I was certain the surgeon would insist that she stay in hospital – at the very least – until the next morning.

****

I was shocked when Margaret rang me at about 7.30 that evening.

I was even more shocked at what she told me.

“Come and take me home!  The surgeon says he has never seen the cancer look so small!  He says I can go home!”

I immediately drove to the hospital and brought Margaret home.

I had written letters of complaint to HCF and to the Ombudsman.

The result of me writing my two letters was immediate.  Without any additional treatment between Wednesday 1^st December and the operation on Friday 3^rd December, the cancer had shrunk dramatically and Margaret was able to come home.

****

I had learned how to keep Margaret alive.

To keep Margaret alive, all I had to do was force the health insurers to obey the law.

I knew I would do what I had to do to keep Margaret alive.

I would force the health insurers to obey the law.