December 1, 2023

Health Insurance

Follow Your Health Insurance

This Sask. man had a stroke in Arizona. His family awaits massive bill after insurance claim denied

After a man from Halbrite, Sask., had a stroke while vacationing in Arizona, his family learned they were on the hook for a $56,000 flight home — and other medical bills yet to come in — as their health insurance claim was denied.

“He has forgotten how to talk, how to swallow,” Rebecca Fee said, talking about her grandfather who she said has been like her father.

Fee said her grandparents, Louis and Arlene Lamothe, are avid snowbirds and spend half the year in Yuma, Ariz.

On Feb. 3, around 6 a.m., Arlene found Louis on the floor. He had suffered a stroke and was paralyzed on the left side. Louis was airlifted to Banner – University Medical Center in Phoenix. The next day, Fee drove for 30 hours from Estevan, Sask., to be with her 80-year-old grandmother.

“He was immediately intubated. He had a lot of heart problems after this,” Fee said. “He was in ICU for two weeks and now his breathing tube has come out.”

A man clad in a black suit stands next to a woman in a white top.
Louis and Arlene Lamothe have been travelling south to Yuma, Ariz., for 10 years. But after the recent incident, the couple may never go back. (Submitted by Rebecca Fee)

About 16 days into their stay there, the family learned their Blue Cross insurance was not covering their medical fees and her grandfather was denied coverage.

Fee said the insurance company argued it was because Louis Lamothe did not disclose a change in cholesterol medication, which he had been taking. Louis was on a 10-milligram pill in Saskatchewan, which was increased to a 20-milligram dosage in July, three months before he left for the U.S.

Lamothe also suffered from chronic obstructive pulmonary disease.

Fee said that because the 10-milligram dosage increase was not communicated, Blue Cross declined to insure Louis for his hospital stay or flight home. The family said they do not know why Louis did not disclose the change in medication but say it was not deliberate.

“It was a major shock when insurance folks said we are on our own,” Fee said, noting Louis filled out his application correctly disclosing he had a previous heart attack and lives with chronic obstructive pulmonary disease.

“He would not have hid a 10-milligram cholesterol dosage change. So, whether he forgot as a 72-year-old that this dosage change even happened, or that he even knew, we can’t confirm it.”

The family has not received the bill for his 24-day hospital stay in Arizona, but believe it will easily be a couple of hundred thousand dollars.

Fee said the family doesn’t know how to prove to the insurance company that Louis did not deliberately hide this, but rather it was a minor error.

“I’m just disgusted with them. It is absolutely unbelievable and unfair.” Arlene said. “He is a very honest man and he would never try and scam anybody.”

Fee said had her grandmother been on the policy, her insurance would have been cancelled too.

A man is lying unconscious in a hospital bed.
Arlene Lamothe holds on to her husband’s hand. Louis experienced irregular heartbeat, migraines, brain swelling and breathing issues while hospitalized. (Submitted by Rebecca Fee)

 With the medical bills piling up, they sold their belongings in Yuma, including their RV trailer and shed there.

“We were wiping his mouth, washing him and turning him and putting cold cloths on his head every few minutes. There was a lot going on with me being 14 hours on the phone every day to even try and find time to fight insurance on this.”

$56K up front for flight

Once Louis’s situation was stable, the family was asked to transfer him to another hospital in Canada. Fee said travelling by road was not an option with Louis’s oxygen supply and feeding tube. 

The family found Angels of Flight Canada Inc., an Ontario company providing medical flights, which flew him to Regina General Hospital on Sunday night.

“The only downfall to this was it was $56,000 which needed to be paid up front. Not a lot of people have that sitting in their accounts to be just thrown at a medical flight, especially as a pension couple.”

The family and friends came together to offset some costs and started a GoFundMe page to raise funds.

Fee said her immediate family has spent at least $36,000 so far, including $9,000 in hotel, fuel and food expenses in Arizona. The incident coincided with the 2023 Super Bowl held in Glendale, Ariz., which increased costs.

Two women sit at a table.
Rebecca Fee and her grandmother, Arlene Lamothe, go over some of the recent medical bills. They say they hope to work out a plan with the hospital to pay the medical bill that could be easily a couple of hundred thousand dollars. (Adam Bent/CBC)

Fee is worried that the medical bills would be quite high as Louis had multiple CT scans, ultrasounds and X-rays per day in addition to the care of six specialists.

“It would be easily hundreds of thousands in bills. We are just left hanging by the insurance company.”

Arlene said they would work out a payment plan with the hospital.

“We are on pension and can’t send them big money every month. They’ll have to take what we can afford each month,” she said, noting her last resort would be to sell their house in Halbrite.

“We’ll have to pay it off until I guess we die.”

Their public fundraising campaign had raised $16,050 of their $100,000 goal as of Monday afternoon.

‘Got to read the fine print carefully’

In an email statement, Saskatchewan Blue Cross said due to privacy requirements they cannot provide specific details about the claim and claim decisions, but that all decisions undergo a formal review with multiple stages involving both internal and external experts.

“It’s an active and consultative process from the point of purchase to ensure plan members understand their coverage, its limitations, and the appeals process available should any new information emerge that warrants additional consideration in a claim decision,” the statement said.

“Travel insurance is essential, and it’s critical that individuals understand what they are covered for and provide accurate medical information when purchasing coverage. It’s equally essential to ensure that you update your travel insurer when health circumstances change.”

Marvin Ryder, professor of business at McMaster University, says reading the fine print is essential for customers to understand the scope of their insurance coverage. (Marvin Ryder)

Marvin Ryder, a professor of marketing and entrepreneurship with the DeGroote School of Business at McMaster University in Hamilton, said although Lamothe’s medication was increased by a “fraction of a gram,” that change is still relevant to insurance companies to ascertain their amount of medical coverage.

“Even if it’s an inadvertent detail, it is still enough to cause the insurance company to say it may not be a big deal to you, but it is to us,” Ryder said.

“Saskatchewan Blue Cross covers over 130,000 people. It’s just not possible for some of these volumes to provide individual response. I’m not saying the company does not have some fault here for seeking clarity and following up.”

Ryder said when it comes to these insurance policies, customers have “got to read the fine print carefully” and understand the extent of coverage.

“Don’t just buy and assume the best. Check it out for yourself.”

Fee echoed that sentiment, and said a speech pathologist is now working with Lamothe to develop his speech and learn how to swallow.

“Just to see him open his eyes and nod his head and see some progress is a blessing. He is the happiest and most caring person. It sucks it happened to them,” she said.

“They had been going down to Yuma for 10 years, but I doubt they will ever go back down again.”