A Saskatchewan family is coping with an insanely high medical bill and other expenses after a man suffered a stroke while in Arizona and was denied medical coverage.
Louis Lamothe of Halbrite, Sask is now in a Regina hospital. He is paralyzed on the left side, has forgotten how to talk, and is using a feeding tube as he is unable to swallow, according to his granddaughter Rebecca Fee.
"He was in the ICU for over two weeks," said Fee, who made the 30-hour drive south to help her grandmother with the situation. "We were about 16 days into his hospital stay when Blue Cross called us to say that they were denying his claim. This was due to a 10 milligram prescription dosage change for his cholesterol pill."
"He was a very honest person...he told them about his COPD, which is a lung disease. He told them about his prior heart attack. He would not have hid a 10 milligram dosage change for his cholesterol pill. So whether he forgot about it at 72-years-old, or whether he even knew in the first place...we're still trying to determine that."
Lamothe suffered the stroke on Feb. 3. He was finally flown home on Sunday on a medical flight, at a cost of $56,000. Fee said the hotel costs in Phoenix came out to about $8,000. The medical bill for the ICU stay in Arizona is expected to be more than $200,000 US.
"He had multiple scans every day. They were doing two CP scans a day to monitor the swelling and the bleeding in his brain. They were doing multiple chest x-rays, they were doing scans on is heart, ultrasounds, kind of everything."
Fee said they've started a GoFundMe page to help cover some of the costs.
"If they don't accept small bill payments or small monthly payments, they're probably going to be homeless," she said. "We're looking into getting lawyers, and I've got an appeal process started with Blue Cross to try to fight this. Just doing what we can right now."
In an emailed statement to DiscoverEstevan, Saskatchewan Blue Cross said they are unable to comment on individual cases due to privacy reasons.
"We remain confident in the handling of the Lamothe claim overall, and 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.
"Our top priority is to pay valid claims and support individuals we serve who are experiencing unexpected travel events. Less than 1% of personal travel claims are denied due to false statement or application omission. When claims are denied, assistance to facilitate repatriation arrangements is always offered to plan members to alleviate that administrative burden during a time of need, and plan costs are refunded."
Blue Cross also warned that travellers should have a thorough understanding of their coverage so there are no surprises.
"Travel insurance is essential, and it’s critical that individuals understand what they are covered for and provide accurate medial information when purchasing coverage. It’s equally essential to ensure that you update your travel insurer when health circumstances change. If you’re ever unsure about your plan contract, we urge individuals to reach out to their insurers for support before travelling."
Fee said there were no other reasons given for the cancellation other than the dosage increase.
"That is 100 per cent their only reasoning," she said. "I want people to know, the smallest change in any prescription, I guess it doesn't matter whether it's relevant to the stroke or relevant to anything, it can void your insurance immediately."
"If my grandma had been on the same policy as him, her travel insurance also would have been cancelled immediately upon their decision."
Fee said the whole ordeal has taken quite a toll on her family.
"We had to sell all their stuff down there, pack everything up. And I mean my grandma's 80-years-old, so I did that on my own," she said. "We had to drive back, it took us three solid days of driving to get back home last (Sunday) night. She is now on her own, and of course he did everything...she's in the early stages of Alzheimer's."
"It's a completely life-changing event. We don't know how he's going to recover or how he's going to be after this."