Blog NO.162 - HCF Explains Its Refusal to Pay lift Treatment Claims – Part 1: 30 January 2025

 

Me climbing the bottom of Croagh Patrick 16th of September 2019.

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View from Louisburgh Ferry, Ireland 16th of September 2019.

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The purpose of Sheena Jack’s letter of 6th of May 2022 was simple – implement Bulls**t Baffles Brains.

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This is the first part of my dissection of the letter.

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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?

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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?

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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”.

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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.

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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.

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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.

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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.

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Blog No. 161 – Putting Broomsticks Up Some Backsides, Part 7: 29 January 2025

Margaret’s Pretend Friend Anne Ryan on the 5th of January 2020

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New Zealand, 5th of January 2020

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3 May 2022 Letter from Sheena Jack

Correspondence with HCF Chief Executive Sheena Jack, May 2022.

Communication	Communication Length	Sent	Response Date	Response Length	What Response Said
Emailed letter 3 May 2022 from Sheena Jack	1 ½ pages	11.59 am 3 May 2022 from sjack@hcf.com.au	4 May 2022	6 lines	I sought Mark Johnson private email address
Email to Sheena Jack 4 May 2022	8 lines	9.50 am 4 May 2022 to Sjack@hcf.com.au	6 May 2022	4 lines	I got Mark Johnson HCF email address
Email from Sheena Jack 6 May 2023	3 lines	5.54 pm 6 May 2022 from Sjack@hcf.com.au		13 page letter to Mark Johnson	Cannot summarise

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I didn’t waste energy replying to Sheena Jack, but I wrote 13 pages to Chairman Mark Johnson.  Sheena Jack said she sent her letter to Mark Johnson, but this seemed doubtful.  More likely, NONE of the HCF Directors had received what I had sent them.  

Sheena Jack had laughable reasons why HCF refused to pay for the Lift treatments; the letter indicated HCF would continue ignoring the law, but it seemed Sheena Jack was becoming nervous.  

On May 12th, 2022, Lynette Macks, HCF Head of Membership, sent an email asking me to send all future Lift claims to her, not Junita Lindsay.    

Because of the Sheena Jack letter and the Lynette Macks email, I assumed HCF would pay our future Lift claims on a “grace and favour” basis.  The new HCF strategy was:

• Pay us as a “grace and favour”.

• Stop paying when it is safe to stop in the future.

• Don’t pay anyone else.

• Block information to HCF Directors about HCF disobedience of the law.

For the first time, the Sheena Jack letter set out legal reasons why HCF had not paid the Lift claims.  This “explanation” ignored the law, but HCF had finally put forward some reasons.  I could make good use of this “explanation”.

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Here is the Sheena Jack letter.

3 May 2022 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). 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. 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. 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). 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. 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. 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). HCF rejected the majority of claims lodged in relation to Margaret's treatment at Lift because the Type C certificates accompanying the claims did not include the reasons why the medical consultations were required to be provided at a hospital (as required by rule 7 of the Private Health Insurance (Benefit Requirements) Rules 2011). While HCF does not challenge the clinical assessment of any practitioners at Lift that the nature of Margaret's medical condition means she requires supervision during her exercise sessions, the exercise session is not the Type C procedure. The exercise session does not have an MBS item number and is not recognised by Medicare. Rather, the GP consultation is the Type C procedure with an MBS item number. In order for Lift to claim hospital level benefits for attending Lift for exercise classes, the doctors must certify that the GP consultation must be undertaken in hospital (as opposed to the exercise sessions). Lift's doctors have not certified this. Handling of your complaint  While I have explained above that HCF has rejected Margaret's claims for hospital benefits on the basis that the claims have not complied with the relevant regulatory requirements, there is a separate issue relating to the handling of your complaints when making these claims and seeking information from HCF. HCF will undertake a thorough investigation into the way your complaints have been handled which will assist us to improve our complaints handling procedures and ensure that the correct information is consistently conveyed to our members. HCF will investigate each of the allegations you have made in your letter, including in relation to the claims that are missing from HCF's claims history record for you and Margaret and your interactions with Ms Lindsay and Ms Harwood. While contact was maintained during the investigation of your complaint, HCF was advised by the Ombudsman on 2 February 2022, that you remained dissatisfied with the outcome and the complaint was escalated within the Ombudsman’s service for their investigation. As part of that escalation, the Ombudsman requested that HCF did not correspond with you about this matter while they conducted their investigations, our apologies for any frustration this may have caused.  I trust this letter clarifies HCF's position on the claims made by Lift, HCF will continue to engage with the Department of Health on the payment of hospital benefits for Type C procedures.  In closing I would like to apologise again if HCF failed to provide clarity in its communications on this issue and the time and energy you and Margaret have spent seeking answers.  Yours faithfully,  Sheena Jack CEO & Managing Director  Copy to: Mr Mark Johnson, HCF Chairman

Blog No. 160 – Putting Broomsticks Up Some Backsides, Part 6: 28 January 2025

Although HCF had taken steps to prevent its Directors from receiving any communications from me, I successfully sent letters to HCF Chief Executive Sheena jack and HCF Chairman Mark Johnson.

To achieve anything, it is essential that you get the attention of relevant people.

Sheena Jack and Mark Johnson were worried because of what I was doing. 

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Margaret in Sydney on the 31st of March, 2019. The art was gifted to me by a good friend. 

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Photo of a kangaroo I took on the 23rd of February, 2019.

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HCF Bar on Communication With Directors

Email addresses for HCF Directors were publicly available, but HCF had taken steps to ensure that people like myself could not communicate with any Directors except Chairman Mark Johnson and Chief Executive Sheena Jack, who held the Managing Director title.  The bar to prevent access to the Directors must have been put in place before my 11 April 2022 letters.  HCF had taken steps to ensure that any attempts to communicate with the Directors of the company, had to be funnelled through the Chief Executive or (possibly) through the Chairman.  

Although all Directors were legally liable for the actions of the company, the company had taken steps to ensure any information received by its Directors was approved in advance by either the Chief Executive or (possibly) by the Chairman.

Preventing communication with Directors through the official company channels meant it was physically impossible for these seven Directors to be satisfied that they were carrying out their duties in the manner required by law. 

As a matter of law, Directors must act independently and ensure the companies they are Directors of, obey their legal obligations.  Independence is physically impossible if paid company employees are their only source of information.  I was attempting on the 11th of April 2022 to bring to the attention of HCF Board members, serious concerns about ways in which HCF was disobeying the law Directors.  Some weeks later, the HCF Chairman told me in writing that the issue in my letters had been discussed at a Board meeting.  I have no idea if the HCF Chairman told me the truth when he made this claim.  It is possible that the other HCF Directors were never told about the issues I raised in my letters.  

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First Email From HCF Chief Executive

My first ever communication from Chief Executive Sheena Jack arrived at 5:05 pm on the 11th of April 2022.  Although it said nothing, it was important.  The lack of spaces between paragraphs in this copy, reflects the layout of that very first email.

Dear Mr Hankin Firstly I am very sorry to hear of Margaret’s health issues.  Thank you for providing this detailed feedback and my sincere apologies for the issues you and your wife have experienced.   I will commence an investigation immediately and will provide a response as soon as possible. Best wishes Sheena Jack Chief Executive Officer & Managing Director

I knew no reliance could be placed on the Sheena Jack claim that she would “commence an investigation immediately and [would] provide a response as soon as possible.”  Sheena Jack certainly already knew about my complaints about the refusal of HCF to obey the law.  

The importance of the email was that I had received a response from Sheena Jack and that the response had been sent almost immediately after I emailed my letter to her.  The HCF Chief Executive was not happy that I had written personally to every HCF Board member.

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I was no longer another unhappy customer.  I had become an unhappy customer who was making trouble with the HCF Board and its Chairman.

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I thought I might be having an impact on HCF when I received my second Sheena Jack email later that same day.  I thought it increased the possibility that something might be done.

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I had sent this email to Sheena Jack at 5:08 pm on the 11th of April.

Dear Ms Jack, My attempts to email letters to the Directors of HCF failed except for you and Mark Johnson.  Fortunately, Mr Barrington sent an auto reply saying that queries should be addressed to you.  It is clear that the official published email addresses for all Directors except you and Mr Johnson have been disconnected. I am therefore attaching to this email, all of the letters that I was unable to send by email to your fellow Directors of HCF because of the disconnection of their officially published email addresses.  I am certain that (however reluctantly), you will forward this correspondence to the intended recipients of the letters.  The law requires this and in any event they will also be sent by express mail. John Hankin

The second Sheena Jack email arrived at 6:31 pm on that same day.  Sheena Jack was located in Sydney, so it had been 7:01 pm in Sydney when she sent it.  

Overwhelmingly, most of my HCF communications were routine.  I was astonished to get an answer to my 5.08 email just one hour and 23 minutes after sending it.  The second Sheena Jack email said this.

Dear John  Thanks for your email and yes I confirm that I will provide copies to all Directors. Kind regards  Sheena Jack Chief Executive Officer & Managing Director

1 hour and 23 minutes after receiving my very first email from Sheena Jack, I was no longer “Mr Hankin”.  I had become John.  I knew we would never be friends.

I received nothing else from Sheena Jack that April.