Saturday, January 25, 2025

Blog No. 157 – Putting Broomsticks Up Some Backsides, Part 3: 25 January 2025

I knew the health insurers were engaged in a criminal scam and I was certain the Ombudsman was actively helping them.  HCF thought it could make me go away by paying $8,623.00, but I was not for sale.  

On 11 April 2022, I sent personal letters to every Director of HCF, Teachers’ Health and NIB.  I pointed out their personal liability for the crimes committed by their companies.

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Margaret and me on the 13th of August, 2016. We were in the city of Victoria, Vancouver Island,

British Columbia, Canada.

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Margaret on the 5th of September 2016 in Alaska.

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The following Table summarises my correspondence with HCF Director and Board Chairman

Mark G Johnson in April 2022.

Communication Details

Length of Correspondence

How Sent

Date of Response 

Length of Response

What Did Response Say?

“Relevant Legal Obligations that Bind All Private Health Insurers”

4 pages

Sent by email to mjohnson@hcf.com.au at 3:03 pm on 11 April 2022

No response

Zero length

No response from Mark G Johnson

* “Relevant Legal Obligations that Bind All Private Health Insurers”

4 pages

Sent by email to mjohnson@hcf.com.au at 3:03 pm on 11 April 2022

No response

Zero length

No response from Mark G Johnson

Letter dated 11 April 2022

12 pages

Sent by email to mjohnson@hcf.com.au at 11:30 am on 12 April 2022

No response

Zero length

No response from Mark G Johnson

Letter dated 11 April 2022

12 pages

Sent by Express Post tracking number 02 01006 90494 20060 50992 on 13 April 2022 to The Hospitals Contribution Fund of Australia Limited, GPO Box 4242 Sydney New South Wales 2001

No response

Zero length

No response from Mark G Johnson

“Relevant Legal Obligations that Bind All Private Health Insurers”

4 pages

Sent by Express Post tracking number 02 01006 90494 20060 50992 on 13 April 2022 to The Hospitals Contribution Fund of Australia Limited, GPO Box 4242 Sydney New South Wales 2001

No response

Zero length

No response from Mark G Johnson

* The same document was accidentally sent twice on 11 April 2022 instead of the letter plus document.

Because he was Chairman of the HCF Board, I intended to send the first letter to Mark Johnson.  I mistakenly attached an additional copy of my document “Relevant Legal Obligations that Bind All Private Health Insurers” instead of the letter.  My letter to Mark Johnson was sent at 3:03 pm on the 11th of April, 2022.  I sent the letter to Mark Johnson at 11:30 am on the 12th of April, 2022.

I think there were probably two reasons why my email to Mark Johnson did not trigger an automatic “Access denied” response from HCF.  Although the Mark Johnson letter was the first one that I intended to send, I inadvertently did not send the letter to the Mark Johnson email.  Nevertheless, the email to Mark Johnson may well have triggered a warning to HCF executives through the HCF computers.  I believe this warning was installed to immediately alert HCF about any emails from my email address.

Apart from Mark Johnson, the only HCF Director whose email was allowed through the system was the one addressed to HCF Chief Executive Sheena Jack.

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This Table summarises my correspondence with HCF Managing Director/ Chief Executive Sheena Jack in April 2022.  Sheena clearly knew what her company had been doing, but pretended not to.

Communication Details

Length of Correspondence

How Sent

Date of Response 

Length of Response

What Did Response Say?

Letter dated 11 April 2022

12 pages

Sent by email to SJack@hcf.com.au at 3:11 pm on 11 April 2022

Email received at 5:05 pm on 11 April 2022

6 lines

“my sincere apologies”; “I will commence an investigation immediately”

“Relevant Legal Obligations that Bind All Private Health Insurers”

4 pages

Sent by email to SJack@hcf.com.au at 3:11 am on 11 April 2022

Email received at 5:05 pm 11 April 2022

6 lines

“my sincere apologies”; “I will commence an investigation immediately”

Letters dated 11 April addressed to Terry Agnew, John Barrington, Michael Bassingthwaighte, Catherine M Hallinan, Claire L Jackson, Lisa McIntyre and Christopher Wright

1 page email plus 7 copies of letters: 12 pages x 7 = 84 pages of letters

Total: 85 pages

Sent by email to SJack@hcf.com.au at 5:08 am on 11 April 2022

Email received at 6:31 pm on 11 April 2022

3 lines

“I confirm I will provide copies to all Directors”

Individual copies of “Relevant Legal Obligations that Bind All Private Health Insurers” for Terry Agnew, John Barrington, Michael Bassingthwaighte, Catherine M Hallinan, Claire L Jackson, Lisa McIntyre and Christopher Wright

4 pages x 7 = 28 pages


Total: 28 pages

Sent by email to SJack@hcf.com.au at 5:08 am on 11 April 2022

Email received at 6:31 pm 11 April 2022

3 lines

“I confirm I will provide copies to all Directors”

Letter dated 11 April 2022

12 pages

Sent by Express Post tracking number 02 01006 90493 70060 5098 on 13 April 2022 to The Hospitals Contribution Fund of Australia Limited, GPO Box 4242 Sydney New South Wales 2001

Letter received by email at 11:37 am on 3 May 2022

2 pages

First ever “explanation” of claimed legal justification for refusal to pay Lift treatment claims

“Relevant Legal Obligations that Bind All Private Health Insurers”

4 pages

Sent by Express Post tracking number 02 01006 90493 70060 5098 on 13 April 2022 to The Hospitals Contribution Fund of Australia Limited, GPO Box 4242 Sydney New South Wales 2001

No response

Zero length

No response to this document

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The email to HCF Managing Director and Chief Executive Sheena Jack was sent at 3:11 pm.  I sent the first email to Chairman Mark Johnson and all other emails went in alphabetical order of the surnames of Directors.  Jack was fifth in alphabetical order.  This is a summary of the times that the emails and other documents were sent and the response of HCF to my attempts to contact the Directors.

Director

Time Email Was Sent

Treatment by HCF System

Mark G Johnson (letter accidentally omitted)

3:03 pm

Presumably delivered

Terry Agnew

3:06 pm 

Access denied at 3:07 pm

John M Barrington

3:07 pm

Access denied at 3:08 pm

Michael J Bassingthwaighte

3:09 pm

Access denied at 3:09 pm

Catherine H Hallinan

3:10 pm

Access denied at 3:11 pm

Sheena Jack

3:11 pm

Definitely delivered

Claire L Jackson

3:12 pm

Access denied at 3:14 pm

Lisa M McIntyre

3:14 pm

Access denied at 3:15 pm

Christopher E Wright

3:15 pm

Access denied at 3:16 pm

The Sheena Jack email was in sixth place in the sending order and it was definitely delivered.  The 11 April email to Mark Johnson (which mistakenly did not have the letter attached), was also apparently delivered to him.  The 12th of April email, which did have the letter attached, was also apparently delivered.

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The emails with the attached letters to the Directors produced a result that none of my letters to the HCF official hierarchy had ever produced.

I was getting closer. 


Friday, January 24, 2025

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.


Thursday, January 23, 2025

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. 




Wednesday, January 22, 2025

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.