Posted on 02/28/2023 5:04:31 PM PST by nickcarraway
The family of a Saskatchewan man who suffered a stroke in Arizona says he racked up hundreds of thousands of dollars in medical bills after his insurance company denied coverage.
According to his granddaughter Rebecca Fee, Louis Lamothe had a "massive stroke" on Feb. 3 in Yuma, Arizona where he spends winters with his wife. The stroke left him paralyzed on one side, and unable to speak and swallow.
While Lamothe had taken out travel insurance, Fee said her family was devastated to learn he wouldn't be covered.
"We had no words we just sat in the hallway and cried," Fee said, recounting the moment her family recieved the news at the Arizona hospital where Lamothe was being treated.
"One of his primary doctors walked past us just as we got the news and he said 'Do you need something?' … and I said insurance just denied our claim and his jaw just hit the floor."
Get the CTV News app for local breaking news alerts and top stories According to Fee, Lamothe's insurer, Blue Cross, denied coverage due to a 10-milligram increase in a cholesterol medication he takes that was not reported to the company.
"They wanted me to confirm his dosage for this cholesterol pill and of course I confirmed it right away. I found the bottle (and told Blue Cross) its 20 milligrams," Fee said.
"It wasn't until five days later that they called us and said 'Well his dosage changed so your claim has been rejected.'"
Fee said her grandfather wouldn't hide information intentionally and may not have been aware that his dosage had been increased.
"My grandpa was very honest on his application. He disclosed a lung disease — he has COPD. He disclosed a heart attack. He would not hide a 10-milligram cholesterol pill change," Fee said.
"It was just disgusting that they just said 'your contract's over; we're done. We'll refund your policy amount. Good luck,’" Fee said.
She estimates that the family racked up "hundreds of thousands" of dollars in medical bills during his three-week stay in a U.S. hospital, plus more than $56,000 to cover the cost of a medical flight to safely transport him to Regina General Hospital.
Fee and her husband paid $36,000 for the flight out of their own pocket and the rest of the money was raised by selling her grandparents' RV.
Fee said the crushing debt from her grandfather's medical care and other costs incurred by the family is compounded by the fact her grandmother has an early Alzheimer's diagnosis.
"When you think you've followed all the right steps and you've paid all this money for coverage," Fee said.
"Like my grandma was just absolutely in shock. She couldn't even function for the first two days after we got that phone call."
Fee has started a GoFundMe to help cover the costs the family is facing and said she's "grateful" for the support they've received so far.
"It was such a learning curve and we thought we had it all covered and there is just still so much to deal with."
BLUE CROSS RESPONSE
In a statement provided to CTV News, Saskatchewan Blue Cross said while it can't provide specific details concerning claims, the insurer is "confident in its handling of the Lamothe claim overall."
"Our hearts are with the family during this difficult time. We are in active contact with the Lamothe family regarding the appeals processes available to them," the statement said.
In its statement, Blue Cross said all decisions "undergo a formal review with multiple stages involving both internal and external experts including medical care providers."
"As a not-for-profit insurance provider, our top priority is to pay valid claims and support individuals we serve who are experiencing unexpected travel events," the insurer said.
"Less than 1 per cent of personal travel claims are denied due to false statement or application omission."
I’m not a shill for insurance companies, have been screwed by them like most folks, and also feel sympathy for the patient and his family. But perhaps the patient either was not as forthcoming on his application as the story suggests, or the policy had exclusions.
Common sense says that the premium for insuring someone posing this much risk would be so high that the company would either decline coverage or make the policy affordable by excluding coverage for heart attacks, strokes, lung transplants, etc. If BlueCross screwed up and undertook to cover what happened here, they should eat the claim. If the lipitor dosage issue really is the only excuse BlueCross has for denying the entire claim, the insured needs to sue — it would not hold much water in court.
But if we had universal government health care like in Canada.....
Oh wait...
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.