8 YEAR OLD WITH LEUKEMIA UP AGAINST AIG’s MORAL COMPASS: plus 7 tools to Deal with Insurers!

Little Jack & his sister Trisha in Paris!

Jack was 8 years old and in the midst of chemotheray treatments when he was awarded a fully paid trip for his family to France’s artistic and sacred places.  He and his family experienced a modern day pilgrimage  afforded by donations in his state and by AIR FRANCE. 

As a precaution along with his two forms of health insurance, medicaid funded BlueCross of Rhode Island and private  Bluecross of Mass, the A NONPROFIT paid for an AIG travel policy to cover for the unlikely event of sudden illness ,transports or hospitalizations.   This seemed like a prudent and worthwhile expense.  

Thus, it was with great dismay when Jack developed a life-threatening case of shingles,  a varicella infection (  this is recurrent or secondary type of chicken pox)  and required hospitalization in DAX ,France,an ambulance transport  with a physician , and hospitlaization at France’s ,Pediatric Cancer Hospital, Hopital Necker in Paris. 

Based on recent corporate behaviors making the front pages of the news worldwide, can you imagine, for a moment how AIG took care of little Jack ? Did they do the right thingbased on their contract? Did they provide standard of care? Or did they look to make a profit? Hum? Read on….

Our nonprofit team was on the overnight train from the southwest of France when Jack’s mom noted a mounting fever as she prepared him for bed. We were required to disembark in the next city, DAX. The city hospital was fabulous and provided a direct admission to the pediatric ward, a pediatrician arrived at near 3am and began the lifesaving, antiviral, IV therapy. During this detour of our pilgrimage to the sacred and artistic sites of France we confronted the following :

                         ps look below for proactive ways to use this experience in positive way!

1.     1.  AIG refused to provide both hospitals with needed documentations of Jack’s coverage

2.        AIG would REFUSE  to make any attempt to pay expenses.  (Hospital Necker was appauld to know that USA ‘s insurers were so willing to leave claims unpaid while their profit margins proved excessive and remarked that this negligent behavior  reflected worse t
han third world nations efforts.
3.       AIG ‘s physician on call at that time refused to supply his own medical/physician escort on the emergency transport.
4.       AIG was noted by the french medical staff to have asked me to serve in that role though they denied this too !
5.       AIG never paid for the ambulance fees ,physician fees nor the hospital fees .

 

Being the hotheaded patient advocate known to protest, call out the newspapers, and insurers for denied medical care or coverage, I could not let this intentional negligence go unaddressed.  Thus upon my return to the states I contacted AIG and  a conference call ensued with myself,the physician who had been on call, the quality assurance representative and the medical director.

 

Here is where things really became unbelievable to me!

 

Rightyou guessed it, they denied any responsibility, the on-call physician lied , and the Medical Director lied- WOW,when I heard this I responded like any naive physician would,

 I asked if they were aware  that this represents a very slippery slope!-like they cared!

How could they  place their profits before their patient obligations?

I asked if they were aware of the impact of their actions in the long haul ?

Were they , in a small way ,by denying their obligations for little Jack , revealing to me and yo themselves,an even the bigger issue-- which was the erosion of their core values and moral obligations?  

 

Yes, you are right if you think that , they probably thought that I was spitting in the wind, I had no power to change their behavior,though I threatened legal action but, could not afford it.

So was I surprised by their being at the center of the economic meltdown which has infected worldwide economies? No, unfortunately I was not.

 

The whole situation disappointed ,angered and saddened,and might I say, exhausted me(,mind you I too, was on a monthly chemotherapy and adjevunct treatment for nearly the 4th year at the time!

So as an Ivy League community pediatrician abroad all too familiar with both the clinician side and the patient side, I was livid- that they could dismiss a child's medical care in the same way which they dismissed the Congressional questioning , like the current outrage about the bonuses being paid to their financial leaders( with American tax payers money.)  

THE GOOD NEWS:

Jack is playing HIGH SCHOOL FOOTBALL now nearly 10 years later.

Seven Proactive Steps for Dealing With Your Insurers 

CARRY A BIG STICK!,no,just kidding!!!

1.        Recognize the system is geared for profit even the nonprofit insurers hence while navigating your medical issues

Do not assume they have your best interest at heart be curious, ask questions,document conversations with names and dates and times to create your health diary of accountability.

2.        Read or highlight the particulars of your policies: copays,hospitalizatons,dates of renewals,age specific allowances for care,

3.        When you do get a bill contact the pharmacy or hospital and ask for the noninsured fees schedules and verify your insurers not milking the payments

4.        When a treatment is denied ask to speak with the medical director not a clerk or data processor, stick with it and take his or her name,

5.        Know most states have Health InsurersOversight committees and if you are not getting help from your insurer then notify them by e-mail or letter.

6.        Call them out when they pass off their decisions on the physicians or medical staff, recall most clinicians( have taken an oath) and studied long hours and withgreat expense and  want to help their patients. They are as frustrated as patients and their families.

7.        Do this in small increments ONLY because it is indeed stressful to have to be an advocate when one is sick or caring for a sick family member.In between breath,have a cup of tea, listen to some soothing music or call a friend!