Blog No.164 - HCF Explains Its Refusal to Pay lift Treatment Claims – Part 3: 1 February 2025

Sheena Jack’s letter was stupid and filled with lies.

****

Margaret on July 7th, 2012.

****

Sunset on July 7th 2012

****

I Say Such Stupid Things!

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.

Translation ↓

In English movies, characters sometimes said “Bosh, Poppycock and Balderdash!” This means “Rubbish!”. **** Sheena is lying. **** Baldrick in Blackadder would have been bashed for saying something so idiotic.

****

Our Complaints Policy

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.

Translation ↓

The way in which HCF “handled” my complaints certainly ignored the official HCF Complaints Policy.  This was no accident.  We were treated like rubbish because HCF thought I would go away.  Margaret wife was dying, so of course, I would go away.  HCF probably thought it a pity Margaret did not quickly die to make me go away. **** HCF never intended to follow its complaints policy about the Lift claims.

****

The “Investigation” of the Investigation (1)

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.

Translation ↓

If HCF ever conducted a “thorough investigation” of my complaints, it has never told me the results.  No “investigation” was necessary.  Every aspect of the HCF behaviour followed the instructions of senior management – almost certainly including Sheena Jack. **** Former Premier of Queensland Joh Bjelke-Peterson said no inquiry should ever be happen unless the inquiry result was already known.  HCF already knew the result of its “investigation”.

****

The “Investigation” of the Investigation (2)

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.

Translation ↓

The “missing” Lift claims are still absent from our HCF online official claims’ history. I still wait for Sheena to tell me what she discovered about Junita Lindsay and Rachael Harwood. Ms Lindsay has changed jobs.  I assume Ms Harwood still works for HCF.  I presume both did exactly what they were told to do by HCF management.

****

Rewriting History (1)

While contact was maintained during the investigation of your complaint …

Translation ↓

Stupid; why claim “contact was maintained” with me when I have complained about total lack of “contact”?  An Outright Lie.

****

Rewriting History (2)

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.

Translation ↓

I heard nothing from the Ombudsman until 28 January 2022 when I received a call from Sarah De Sade.  She told me no one had looked at my complaints while she was on extended leave.  She confirmed nothing was done by the Ombudsman and she was awaiting orders telling her what she should do.  I heard nothing about any Ombudsman’s “investigation” until April 2022. **** The “outcome” with which I was dissatisfied on 2 February 2022 was the “offer” made by HCF on 21 January 2022 to pay on an “ex gratia” basis, the gap fees we had paid to Lift - but only if we: Falsely said Lift Cancer Care Services did not tell us the estimated costs of its services; and only if Provided copies of our invoices for the gap fees we paid to Lift Cancer Care. If we did this, HCF would refuse to pay anything for any future Lift treatments. I rejected this by letter dated 24 January 2022.   I refused to lie and I refused to permit HCF to ignore the law.  Sheena Jack turned this into a claim HCF only knew I had rejected the HCF proposal when the Ombudsman told it this on 2 February 2022! Another outright lie. **** On 2 February 2022 Sarah De Sade emailed me saying the Ombudsman had “requested a formal response from …[HCF] in relation to” my complaints and when it received the HCF response, it would “carefully” consider it.  Sarah De Sade “respectfully ask[ed me] not [to] contact HCF about this specific complaint while [she was] investigating.” Neither HCF nor the Ombudsman had done any “investigating” of my complaints as at 2 February 2022 – 2 months after I complained.  This is what really happened. When the Ombudsman received my complaint on 3 December 2021, it did zero. HCF also did zero.  It had a “template” response to complaints like mine and it applied the template – do nothing. HCF made me the 21 January 2022 offer –which had been successfully used in the past. When I rejected the HCF offer, HCF probably told the Ombudsman on 2 February 2022. After being told I had rejected the HCF offer, the Ombudsman requested an HCF “investigation”. This Ombudsman investigation request was what the Ombudsman called “escalation” of my complaint. The Ombudsman did nothing while HCF conducted its “investigation”.

****

The Ombudsman Made Us Do It!

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.

Translation ↓

Sheena Jacks tries to create the impression that the failure to communicate with me was the result of a request by the Ombudsman. Rubbish; HCF continued its policy of ignoring me – hoping Margaret’s health would deteriorate and I would go away. **** Sheena Jack knew the Ombudsman could not conduct any investigation until given permission by HCF.  No “investigations” were conducted by the Ombudsman and the Ombudsman had zero interest.

****

Hopefully You Will Now Go Away

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.

Translation ↓

Hopefully this bulls** has you baffled!  Go away!

****

Bugger Off

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

Translation ↓

Bugger off and don’t come back!  We refuse to pay for services provided by Lift. The law is irrelevant. We have the backing of the Department of Health and the Ombudsman.

Blog No. 163 - HCF Explains Its Refusal to Pay lift Treatment Claims – Part 2: 31 January 2025

Margaret in Alaska (Arctic Circle trip), Wednesday the 7th of September 2016.  It was cold!

****

Margaret and I enroute to the Arctic Circle, Wednesday 7 September 2016.

****

This blog continues the dissection of the lies told by the CEO of HCF in her letter dated 6th of May 2022.

****

Yet More Really Big Lies

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).

Translation ↓ (1)

The theory of Bulls**t Baffles Brains Theory is on full display here.  Sheena Jack is pretending to refer to clause 7 of Part 3, Schedule 3 of the Private Health Insurance (Benefit Requirements) Rules 2011. Clause 7 DOES NOT require the Type C certificate to “include the reasons why the medical consultations were required to be provided at a hospital”.  Sheena Jack has invented a legislative requirement to avoid admitting HCF has broken the law.  This claim is complete rubbish; it is nonsensical. **** Sheena Jack is telling Another Really Big Lie.

Translation ↓ (2)

In putting forward this specific lie, Sheena Jack did not notice that she was contradicting what HCF had claimed to the Ombudsman.  According to the Ombudsman, HCF had sought further information about the Lift claims and this further information had not been provided.  The Ombudsman thought this was an excellent excuse for the refusal to pay the claims. **** If HCF rejected the Lift claims because the Type C certificate did not “include the reasons why the medical consultations were required to be provided at a hospital”, why didn’t HCF claim this to the Ombudsman? Perhaps HCF thought that even the Ombudsman would find it too difficult to swallow this particular lie. **** This was yet Another Really Big Lie.

Translation ↓ (3)

Sheena Jack asserts “HCF rejected the majority of claims lodged in relation to Margaret's treatment at Lift”.   This is more Bulls**t Baffles Brains. Most of Margaret’s Lift claims were NEVER rejected.  If they had been rejected, the Health Department and the Ombudsman might have felt more pressured to carry out their jobs.  HCF did not reject most claims - HCF made them “disappear”.  Because they never appeared in the official claims’ history, there was no need to reject them.  This gave the Health Department and the Ombudsman the excuse they needed to not ask questions about the reasons for rejection. This was yet Another Really Big Lie.

****

Meaningless Words Plus Yet Another Really Big Lie

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.

Translation ↓

Sheena Jack claims she “does not challenge the assessment of any practitioners that the nature of Margaret's medical condition that she be supervised during her exercise sessions”, but she also asserts “the exercise session is not the Type C procedure”.  Because HCF says the “exercise session” is not a Type C procedure”, it will not pay for Margaret’s admission to hospital to receive the exercise therapy.   If this seem to make no sense, this is because it makes no sense. **** Although the medical practitioner who examined Margaret when she attended every therapy session at Lift thought that - for the reasons set out in the certificate completed by that doctor after that examination - Margaret could not have exercise therapy except in a hospital, HCF refused to pay for the hospital admission because while Margaret  was in hospital, she received an “exercise session”. **** This part of the Sheena Jack letter translates into this. HCF accepted Margaret could not safely receive her treatment except in a hospital, but it refused to pay for her admission to hospital because it disapproved of ANYONE having an “exercise session” in hospital.  HCF – an insurance company – claimed to knows more about the proper treatment of Margaret’s (or anyone else’s) cancer than her treating doctors did.  How utterly arrogant and stupid.   No one in HCF studied medicine.   No one in HCF asked for any information about Margaret’s cancer.   Despite this, HCF obviously thought it knew more about how to treat cancer than any of the doctors who referred patients to Lift. **** HCF dis not dispute the opinions of Margaret’s doctors because those opinions were irrelevant to HCF. **** Here, Sheena Jack resorts to meaningless words and combines them with yet Another Really Big Lie.

****

Bulls**t Baffles Brains – Yet Again! 

The exercise session does not have an MBS item number and is not recognised by Medicare.

Translation ↓

Bulls**t Baffles Brains is on full display here. The “exercise session” does not have an MBS number because HCF was never asked to pay Anything for the “exercise session”. The payment that HCF and the other insurers refused to pay was the legislated payment for admission to a hospital. The law says that to be entitled to receive this legislated payment, a “Type C” certificate must be provided to the health insurer in the format set out in the legislation. All certificate submitted for the services provided by Lift Cancer Care Services fully complied with the legislation. Bulls**t Baffles Brains! Yet Again!

****

Even More Bulls**t Baffles Brains!

Rather, the GP consultation is the Type C procedure with an MBS item number.

Translation ↓

Next time Sheena Jack visits her general practitioner, she should ask her doctor whether she is having a medical examination or a Type C procedure. The general practitioner will not know what she is talking about and the GP will probably be so stupid that the GP will think he/ she is conducting a medical examination! Bulls**t Baffles Brains! Again!

****

Somehow, Sheena Jack convinced the Board of HCF that she knew so much about health insurance that she ought to be appointed as the Chief Executive Officer of HCF.

****

Mickey the Mouse probably knows nothing about the law affecting health insurance in Australia.

****

Mickey the Mouse probably knows more about the law affecting health insurance in Australia that Sheena Jack

****

To be continued …

****

Unfortunately, there is even more to come.