Blog No. 156 – Putting Broomsticks Up Some Backsides, Part 2: 24 January 2025

The health insurers were engaged in a criminal scam and the Ombudsman was actively helping them.  They thought they could make me go away by paying us $8,623.00 that the law had always said we were entitled to. 

I was not for sale.  I decided I needed to forcibly shove some broom sticks up some corporate backsides.

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This was Margaret on 16 March 2012.  She looked so healthy then.  I would love to kiss her – not because she was Irish – she was Australian – but because she was Margaret.

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I went camping in the northern flinders Ranges of South Australia in 2011.  I took this photo as dawn was happening on the 29th of May 2011.

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What Should I Do?

I wrote a letter to the Commonwealth Ombudsman on 7 April 2022.  I will put that letter aside until a later blog.  It was obvious the Ombudsman was never going to force the health insurers to obey the law. I knew no help would come as a result of that letter.

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The real problem was that the health insurers were ignoring the law and doing so with the approval of the official regulators – the Australian Health Department and the Commonwealth Ombudsman.

I needed a strategy to force the health insurers to obey the law.  I needed a strategy that would do this with zero help from the official regulators.  My strategy needed to be effective, and it needed to have a possibility of solving the issue quickly.  Unless the health insurers were forced to obey the law, cancer sufferers who ought to be able to have the treatments provided by Lift Cancer Care through their private health insurance, might be forced to go without the Lift treatments that their doctors wanted them to have.  In some cases, this would mean they would die when they ought to be able to live.  In other cases, this would mean earlier death than might ought to be the case.

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Whatever happened, I knew Margaret would continue attending Lift.  No matter what happened, we would find the money somehow – but others might not be able to find the money if their health insurers were allowed to continue ignoring the law.

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I worked out my strategy while meditating in the afternoon of Friday, 8th of April 2022.  Meditation involves trying to empty the mind of normal thoughts.  By trying to empty my mind of all thoughts concerning the health insurers, my subconscious mind was able to give me the solution.  I realised that in reality, the solid wall of resistance erected by the health insurers was nothing of the kind.  The health insurers had built a House of Cards and not a solid wall.  

I could blow down the House of Cards quickly if I used the appropriate strategy.

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The Strategy

All of the health insurers were incorporated companies.  

All companies have Boards of Directors.  

In legal theory, the Boards of Directors act as the managers of their companies and the law recognises them as the company managers.  

Being a company Director (especially if the company is a large one) is a very desirable job.  It brings status and prestige.  The pay is usually very attractive and the job of company Director usually requires very little work.  

Most Directors rely on advice from the paid company employees.  Many Boards of Directors do very little except meet as required and give approval to decisions already made by senior company employees (senior executives).  

I realised I had to remind the Directors of the health insurers that as a matter of law, they were personally liable for the actions of the companies of which they were Directors.  I needed to ensure they knew precisely what their companies were doing.  I needed to point out that they would be liable to criminal and civil penalties unless each and every one of them took reasonable steps to make sure their companies obeyed the law.

I needed to create a situation where the Directors would be held legally liable for the crimes committed by their companies. 

If I created a genuine prospect of personal legal liability for the crimes of their companies, the Directors would make their companies obey the law - because this would be the only way the Directors could avoid personal liability for the crimes of their companies.

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By early April 2022, Teachers’ Health had finally decided to obey the law and it had made an unannounced payment of tens of thousands of dollars into the Lift bank account.  Despite this, Teachers’ Health had not actually told Lift that it would obey the law in future.  As at 9 April 2022, HCF and NIB were still actively breaking the law and refusing to pay for Lift treatments.

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After meditating on Friday 9 April, I decided to write individual letters to every member of the Boards of Directors of HCF, Teachers’ Health and NIB.  My letters would tell every single one of them what I had discovered about their companies.  My letters would point out that because I had in my letters given them all relevant information, they would now be personally liable for the actions of their companies unless they demonstrated they had taken active steps to stop their companies from continuing to act in this way.

I decided to send copies of my letters to the Directors to the Australian Competition and Consumer Commission and I would write separate letters to the Treasurer and the Minister for Health.

I reasoned that surely I would be able to create enough anxiety among enough Directors to ensure they tried to protect themselves against the likely bad publicity and against personal liability for the crimes committed by their companies.

The Practical Steps

The names and contact details of all company Directors are listed by the Australian Securities and Investments Commission.  Obtaining the names and official contact details for the Directors of HCF, NIB and Teachers’ Health was simple enough.  In total, there were twenty six Directors.  HCF had nine; NIB had seven and Teachers’ Health had ten.

I started drafting a template letter on the morning of Monday, 11th of April 2022.  I intended that every Director would receive the same letter but with those changes needed to reflect the differences in company names and the (relatively minor) differences in the way that the three companies had refused to pay the claims for treatments provided by Lift.  

I finished my template letter early in the afternoon of that same Monday.  It was twelve pages long.

Blog No. 155 – Putting Broomsticks Up Some Backsides: 23 January 2025

The health insurers were engaged in a criminal scam and the Ombudsman was actively helping them.  They thought they could make me go away by paying us $8,623.00 that the law had always said we were entitled to. 

I was not for sale.  I decided I needed to forcibly shove some broom sticks up some corporate backsides.

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Margaret on 17 November 2020 before her chemotherapy and radiotherapy.  The women she thought were her friends are also in this photo – Sue Chapman on the left and Anne Ryan centre.

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Margaret in September 2022.  Compared to November 2020, she was skeletal.  Her right kidney had stopped working by this stage.  Her pretend friends Sue and Anne were too busy arranging her cancellation to find the time to visit her in 2022.

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At 2:37 pm on Tuesday 5th of April 2022, I received this email from the Ombudsman.

Dear Mr Hankin Thank you for contacting the Commonwealth Ombudsman about the issues you are experiencing with HCF and Lift Cancer Care (LCC).  I appreciate your patience while our Office investigated your complaint.  I would like to advise that HCF have offered to reimburse you $8,623.00 to cover claims for services at Lift Cancer Care between January 2021 and February 2022.  They will not, however,  be honoring any further claims until such a time as their dispute with Lift Cancer Care has been resolved.   Our Understanding of your situation:  You contacted our Office in December 2021 to complain about issues you were having with HCF not paying your wife Margaret’s LCC invoices.  You explained your wife has cancer and had been attending LCC since January 2021.  You explained that the LCC claims were not being declined by HCF, but being rejected due to lack of information.  This had resulted in a build-up of unpaid claims with LCC, and as a result in December 2021 LCC stopped lodging claims directly with HCF.  You were asked to pay for services up front and then claim directly with your insurer.   This was administratively taxing because claims required additional paperwork signed off by Margaret’s doctors each time a claim was submitted.  In January 2022 you paid LCC approximately $6,000 to cover the cost of  treatment undertaken by Margaret for the previous 12 months because HCF had still not provided benefits to LCC for the claims submitted.  You advised our Office that HCF were now no longer accepting any claims from LCC.    Our Investigation  Investigation revealed that due to claiming issues with various insurers LCC had applied to the Department of Health to have their ‘Tier 2’ hospital status removed.  Removal of this status allowed LCC to bill patients for services directly rather than having to submit claims directly with a patients insurer.  This application was approved, and explains why you were required to pay upfront for services and then  claim directly from your insurer from December 2021 onwards.   It is important to note that the primary function of the Office is to assist consumers with their private health insurance problems.  When administrative disputes between health funds and hospitals are brought to our attention, our main role is to assess the reasonableness of the response from both parties.    In this case, we are of the view that HCF’s request for additional information to support individual LCC claims is reasonable under the current framework.  We are also of the view that LCC have demonstrated they have made every effort to convince HCF to pay benefits for their services.  Despite this effort HCF remain unconvinced LCC is eligible to claim.   In these sort of circumstances, we expect that both parties work together to come to an agreement without the patient suffering any financial detriment.   It is not the role of this Office to make determinations for hospitals and insurers with regard to the correct interpretation of specific rules.  Our role is to help people resolve complaints about their private health insurance as quickly as possible. This Office makes sure an insurer’s decisions are consistent with legislation, policy terms and conditions and their own internal procedures and rules. We are independent and impartial.   Outcome In this case, although the dispute between HCF and LCC remains unresolved to date, HCF has agreed to reimburse you $8,623.00 to cover claims for services incurred at Lift Cancer Care between January 2021 and February 2022.   I am of the view this a reasonable outcome, and that HCF have acted in accordance with the expectations of the Office to resolve your individual complaint.    Going forward we would not expect HCF to continue paying claims from LCC until the dispute is resolved at a higher level. I recognise that this is not the outcome you were hoping for.  Unfortunately the Office is unable to intervene further with the broader issues being experienced by LCC.   I will request that HCF contact you directly with regard to your financial reimbursement of $8,623.00.   As there is no further remedy this Office can provide you in relation to your complaint, I will be finalising our file on this matter.   Your complaint will remain in our system as we report on issues of concern to consumers and your complaint may be used in this regard. Please feel free to contact me if you have any questions.  Kind regards Sarah de Sade Complaints Officer   Private Health Insurance  COMMONWEALTH OMBUDSMAN phone 1300 362 072 email phi@ombudsman.gov.au website www.ombudsman.gov.au

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HCF Email Thursday 7th of April 2022

I received this email from HCF at 10.00 am on Thursday 7th of April 2022.  This is a complete email.

Thu 7/04/2022 10:00 AM Junita Lindsay <JLindsay@hcf.com.au> HCF Membership To: John Hankin Dear Mr Hankin,  We refer to your concerns raised with the Office of the Private Health Insurance Ombudsman (PHIO), querying your HCF policy.  We can confirm that on 4 April 2022 we had finalised the payment of $8,623.00. This once off payment was processed into the nominated direct credit account we have recorded on your HCF policy. We do generally allow up to 5 business days for the funds to clear with your financial institution.  Please let me know if you have any questions.  Kind regards, Junita  Junita Lindsay Complaints Resolution Officer Level 5, 403 George Street Sydney NSW 2000 P 02 9290 8872      E JLindsay@hcf.com.au hcf.com.au

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When I checked, I discovered that HCF had paid $8,623.00 into our account on Tuesday 5th of April 2022 – the same day that the Ombudsman sent me its email.

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The health insurers were engaged in a criminal scam and the Ombudsman was actively helping them. 

I would not stand for it. 

Blog No. 154 – Stumbling Ahead: 22 January 2025

Just as I was about to commence an all out assault on the health insurers to force them to obey the law, I stumbled and fell face down because of a crack in the concrete that was barely visible.

My fall in the dark and nearly broken arm gave the health insurers more time to continue disobeying the law.

After I fell, I got up and kept walking.  Unfortunately, my arm was so badly hurt I was unable to type anything for three weeks.

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This was Margaret in May 2022 when we were at Port Eliot.  We spent three nights in Port Eliot and this was our final holiday together.  When we were there, we both knew the cancer was likely to return soon.  A cat scan on 23 September 2022 revealed that the cancer had blocked Margaret’s left kidney and she was close to death.

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The garden of the holiday house we stayed in at Port Eliot in May 2022.

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Th Fall

In March 2022, I decided I needed to apply what I called the Stimulus System to the health insurers.  This meant I had to make it more painful for them to continue ignoring the law than it would be for them to actually obey the law. Metaphorically, I decided to shove a very big boom stick up the backsides of the health insurers.

As luck would have it, I had a bad fall early in the morning of Tuesday 15 March.  This delayed commencement of the Stimulus System.  

When I finally left hospital in July 2021, I had resumed my daily walks.  These usually happened very early in the morning.  Depending on when I woke up, I often walked in the dark.  Initially, my early starts happened because my illness had completely disrupted my sleep rhythms, but my body continued waking up far too early long after I had regained my health.  Rather than let the inability to sleep become a burden, I turned the early wake ups into a positive by walking whenever I woke up.  I then found the early starts meant I had far more usable time every day and what had started out as an accident became useful.  Since I had more working time every day, I was better able to take care of Margaret and I was better able to continue the struggle with the health insurers.

I was more than one kilometre from home at 5:30 am on 15th of March when my shoe caught on something on the path.  My shoe had hit the edge of a cut in the concrete path; a trench had been dug there and then repaired.  The repair had left an unevenness of less than 13 millimetres (½ inch) where the cut edges of the path had been repaired and rejoined.  My shoe caught on this edge and I fell face to the ground.  It was as if I were a tree with the trunk suddenly cut through.  I tried to shield my face with my hands as I went down.  This limited any visible bodily damage to some grazes on my face and knees and some cuts in my mouth; parts of my mouth had become sandwiched between the concrete and my teeth.  Most of the shock from my fall was absorbed by my left wrist.  The left wrist began aching immediately.

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I was alone in the dark, so I picked myself up and resumed walking.  Even if anyone saw me, it was dark and anyone who might see me would be nervous about helping a stranger in the dark.  I returned home and had breakfast.  The left arm soon became swollen; it was very sore for days.  It was impossible for me to type anything, so dealing with the health insurers had to wait.  

My arm developed an angry rash which felt like it was on fire. The rash began on my right forearm and spread to my left arm and belly.  I ignored the pain of the sore arm and splashed cream across the rash.  The GP ordered an X-ray on the Friday, 18th of March.  This confirmed there were no broken bones in the arm or wrist.  It took four weeks before the rash went away.

I did wonder about the fact of it all and its timing.  The crack that caused the fall was tiny. The likelihood of tripping over that particular crack was extremely small.  I have walked over the same crack many, many times since, and anyone looking at it would say it is impossible to trip over it.  Tiny as the crack was (and still is, because it is still there), the fall did happen and it happened at the commencement of my concerted effort to make the health insurers obey the law.  

Blog No. 153 – Keeping Margaret Alive, Part 4: 21 January 2025

I was on the verge of bringing to an end, the scam operated by the health insurers in relation to Lift Cancer Care.

Neither the Commonwealth Ombudsman nor the Health Department had shown any interest in terminating the scam.

I wonder how many other health providers are still being subjected to similar scams.  I am sure Lift Cancer Care was not the only victim of unlawful behaviour by the health insurers.

Now the struggle with the health insurers was nearly over, Margaret’s cancer had no reason to stay in remission, so it did not.

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Margaret arranged to have this very special birthday cake made for her sister’s Maurine’s birthday in September 2021.  The cake was expensive and it was delicious.

Margaret’s sister Maurine cancelled me on 23 November 2023, three months after Margaret’s death.  She never did tell me why.  Given that Margaret was then dead, I obviously no longer mattered.

By September 2022, Margaret had commenced an increasingly impossible struggle to stay alive.

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I took this photo of Margaret on 19 September 2021.  In September 2021, Margaret had already been cancelled by those she had thought were her friends.

In all of the photos I took after September 2022, Margaret visibly draws ever closer to death.

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In April 2022, Margaret still had a fatal cancer, but for reasons that neither we nor the oncologist could explain, her relative good health continued and the cancer continued to stay out of sight.  Margaret’s next cat scan was not due until June 2022.  Our life continued on the pattern of our new “normal”.  I hoped that perhaps the cancer would disappear; Margaret certainly realised this was impossible.

Throughout that April, I divided my spare time between driving Margaret to her many appointments and forcing the health insurers to obey the law.  Our days were so very busy.  I was worried sick and constantly exhausted.

Margaret had four treatments at lift Cancer Care during April 2022.  This Table summarises the claims lodged with HCF and what HCF did with them.

Date of Clam (April 2022)	Claim Paid or Unpaid?	Notification to Us?
7 April*	Unpaid	No
12 April**	Unpaid	No
20 April***	Unpaid	No
29 April****	Yes – but only as a “discretionary payment”	Yes - email dated 14 June 2022

* Emailed on 4 April 2022 to Junita Lindsay at HCF with Letter dated 5 May 2022

** Emailed on 25 April 2022 to Junita Lindsay at HCF with Letter dated 5 May 2022

*** Emailed on 25 April 2022 to Junita Lindsay at HCF with Letter dated 5 May 2022

**** Emailed on 14 June to Lynette Macks with Letter dated 14 June 2022

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All of the claims I lodged with HCF for treatments given to Margaret by Lift Cancer Care in April 2022 continued to be ignored, but I was starting to have an impact.  The claims I lodged for the treatments given to Margaret on the 7th, 12th and 20th of April were ignored as if they had never been made, just like all previous claims, but strangely, HCF replied to the claim for the 29th of April treatment on the very day I submitted it and told me the claim had been paid as a “discretionary payment”.   This is the mail I received on 17 June 2022 from Lynette Macks, HCF Head of Membership.

Dear Mr Hankin, I am writing in reference to your letter dated 14/05/2022. I acknowledge receipt of your claims and we have now processed a discretionary payment of $705 today for the dates of service of 29/04/2022, 03/05/2022 & 12/05/2022 where you have attached details of your claims and payments made. Please advise if you have made any further payments for services and send them directly to myself so that I can process them in the same way. Following that, I would ask for you to please stop making any payments towards these services as Lift can send the claims directly to us with the appropriate documents to process the benefits. From this point, you will see details of these claims in your claims history rather than it being listed as discretionary payment. Please also let me know if you would like me to provide another up to date claims statement for you. I am happy to discuss this further if you have any questions. Take care, Lynette Lynette Macks Head of Membership Level 5, 75 George St Parramatta NSW 2150 P 02 8852 1770 (ext: 3770)      E LMacks@hcf.com.au hcf.com.au

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By the time I lodged the claim for the treatment given on 29 April, I had been “escalated” beyond the lowly Junita Lindsay to Lynette Macks, HCF Head of membership.  Despite this, according to our official claims’ history record, we never made any of the April 2022 claims for treatments provided by Lift Cancer Care.  

This change in the attitude of HCF did not occur because HCF had realised the unlawfulness and immorality of what it had been doing.  My refusal to let the health insurers get away with their crimes – plus a broadening of my letter war to include HCF, NIB and Teachers’ Health - was finally forcing the health insurers to very reluctantly obey the law.  This happened even though the Australian Health Department (as primary regulator) and the Commonwealth Ombudsman (as the secondary regulator) remained uninterested in the health insurers except to protect them from their legal obligations.