20 January 2014
After spending a pretty rough first day after surgery, I sent Tilly home for a good night;’s sleep. She earned it with her marvelous care the night before. I would tough this night out by myself. I was tired and decided to sleep … just drifting off and the my mobile rings… 20:45.
It was the hospital admissions office… I can barely understand the representative… something about the insurance not covering the bills and I need to make arrangement to pay nearly 7,000 BHD ($20,000 US). My blood pressure hits the ceiling! Why the hell is HE calling me – the patient, less than 36 hours out of major surgery – at 8:45 PM at night? Couldn’t the call have waited until morning? “Hospital Policy”, he says.
The nurses go into overdrive trying to calm me down… I call Tilly to come and get me… Meanwhile I am hooked up to IV drips… painkillers, saline and nutrients and antibiotics….plus an abdominal drain… I am so angry it never occurs to me that I am not going anywhere.
Tilly arrives and we scrounge a wheel chair… and down to the Admissions Office we go. It is the only place I can call the Insurance Company from… the cell coverage in my room is awful and the phone is for local calls only.
IF I am angry at Ahmed (the Admissions agent) for calling so late… I am FURIOUS when the insurance company rep tells me that my condition is classified as a PEC (Pre Existing Condition) … when I ask how it could be pre-existing since I have never had anemia before… the agent tells me “cancer is a chronic condition”. I have never had cancer before either.
The problem is there is NO diagnosis of cancer… I was admitted for severe anemia (life-threatening) and internal bleeding was found to be the cause… the surgery was medically an emergency … requiring immediate action. Until all the lab work is done “CANCER” remains only a preliminary diagnosis. Nevertheless the insurance rep remains unmoved.
I have never been a fan of insurance companies but this just solidifies my feelings. The first thing an insurance company does is to try to figure out a way NOT to pay. So, they reach into their bag of dirty little tricks and tell the ensured that they are not covered because…_______ and hope the insured will just accept that and walk away as one of our colleges did when she was denied coverage (by the same company)for breast cancer three years previous.
I am determined to fight the bastards tooth and nail … ONLY – it is 11:30pm, Tilly has to work in the morning, I am still less than 48 hours out of surgery and this sure as hell this is not helping me to recover… Tilly goes home and I go back to my room… sleepless night for the two of us.
The next morning, during the surgeon’s morning rounds I mention the situation to my doctors… they are incensed. The hospital Admissions Director makes a trip up to my room apologizing for the late night call(s) and shortly becomes a very valuable ally in my struggle with the insurance company… providing insight and advice about this particular company….(i.e.- they deny every claim out of hand).
My employer had already sends a couple of emails, seeking clarification but nothing had changed. Later in the day I remember a blood test I had done in March 2012… 10 months prior in Canada. I accessed a copy online and it showed completely normal Hemoglobin levels AND NORMAL TUMOR MARKERS! I emailed a copy to the Insurance company whose home office is in Los Angeles. I ask them HOW my situation could be pre-existing or chronic given the March 2012 blood test. I then await a response.
During the afternoon the HR person from my school visits and shares the emails she has sent. In one of the responses from the Insurance company the representative stated that indeed I had been covered from my previous tenure at the school (2010 to 2012) but, that I had not been covered from September of 2012 until I returned in Oct of 2013…. further stating “We have no account as to why Mr. [MIKAL] left and returned, and why he returned late.”
The implications were/are very clear…. the decision as to what was covered by the insurance was made NOT by medical fact BUT on conjecture … i.e.- the assumption that I had been seriously ill with cancer and ONLY returned to the school for medical coverage. I BLEW another gasket… firing off an email to the insurance rep I detailed the facts:
” FIRST – IT IS ABSOLUTELY NONE OF YOUR OR YOUR COMPANIES’ BUSINESS WHY I LEFT OR RETURNED LATE. However to answer your question… My wife and I decided to try to retire in 2012 AND ONLY returned because [Our school’s HR REP] asked us to return because she was seriously short of teachers.
Second – Your statement also holds the implication that I returned to Bahrain and [the school] to get medical treatment. I am a Permanent Canadian Resident… who is COVERED 100% under the Canadian Medical Services Plan of my Province! WHY would I travel ½ way around the world for treatment when it was available to me immediately? Further, WHY would I delay treatment until January 2014 when I was in North America in the entire previous YEAR & again in December 2013 visiting in California and could have gone to Canada then?
Your implications are simply insulting and your question immoral. Any decision should be based on the medical facts. I think enough information has been presented by myself AND my doctors AND my hospital that ANY REASONABLE person would conclude my condition was NOT pre-existing.
So in short, I am on the verge of contacting my attorney, to explore any and all legal remedies to this situation. NO DOUBT I will find a very hungry attorney who will lick his chops at the slam dunk case I would present to him.”
It only took until 8 AM the next morning; I (and all parties involved – the Hospital, my school’s HR rep. and my doctors) received an email from the insurance stating that upon reviewing the “NEW” evidence the hospital bills and related charges would be paid in FULL.
I & Tilly had worked for 2 days and 2 sleepless nights, researching and writing emails while trying to recover from major surgery. We have yet to receive an apology. By the way – If I had gone to the Dr while we were visiting in California over Christmas … the bills would have probably topped over $250K… the insurance company got off easy.
No one … absolutely no one should ever have to deal with a situation like this. I think I would rather have the doctors making my medical care decisions and NOT some profit motivated corporate entity.
Clearly this insurance company has made a habit of putting profits before it’s clients. Do all insurance companies?
ENIGMAS 