Tuesday, November 25, 2014

Saskatchewan insurer won't pay for million dollar baby

Reece Huculak is pictured in a handout photo. Jennifer Huculak/The Canadian Press
The Canadian Press
Saskatchewan Blue Cross says it won’t reverse its decision denying the claim of a family facing more than $900,000 in medical bills for an unexpected birth in Hawaii.

Instead, the insurance company said in a statement Monday that Jennifer Huculak should seek help from the national independent insurance ombudsman.

Huculak said she was six months pregnant when she left for a vacation in Hawaii with the blessing of her doctor and health insurance from Blue Cross.

Soon after arriving, her water broke and her premature baby required a two-month stay in an American neo-natal intensive care unit.

Huculak said Blue Cross denied her claim, saying a bladder infection that caused some hemorrhaging at four months constituted a pre-existing condition.

Saskatchewan Blue Cross President Arnie Arnott said Huculak was given “nine specific events” that prevented her claim from being paid and referred the media back to Huculak for further explanation.

He said the challenges facing Huculak’s family are “extraordinary and difficult.”

“A review by OLHI is free of charge and Saskatchewan Blue Cross will cover any costs incurred by Ms. Huculak preparing her claim for review by the ombudsman,” Arnott said in the statement.

Blue Cross aims to “help families avoid situations like this one,” he added.

Huculak didn’t immediately return calls on Monday.

Last week, she said she wasn’t given a Blue Cross questionnaire before the trip.

“We were told we were covered. We paid our premium. We obviously still feel that Blue Cross should cover the bill,” she said. “It’s a very sad position to be in. I wouldn’t wish it on anybody.”

Huculak said if a doctor told her she had a high-risk pregnancy, she wouldn’t have travelled to Hawaii.

She said her doctor sent a letter to Blue Cross confirming that Huculak’s pregnancy was stable when she went on vacation, but the claim was still denied.

“As of March, Blue Cross pretty much washed their hands of the whole case,” she said. “We’ve just kind of been sitting ducks not knowing what to do.”

The hospital in Hawaii has declined comment.

Andrea Zviedris, spokeswoman for Ombudservice for Life and Health Insurance, said reviews only take place when consumers approach the organization.

“Once they reach out to us for help, we can look at their case,” she said in an email, adding that she can’t speak to the specific situation.

Zviedris said that many Canadians believe once an insurer denies their claim, the only recourse is a costly court proceeding.

She said her organization provides non-binding recommendations for insurers.

“To date, all final settlement recommendations OLHI has made in favour of the consumer have been accepted by the insurers,” she said.

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