Emil Lendof/The Daily Beast
Emil Lendof/The Daily Beast

Malcolm MacDougall, a prominent speechwriter and creative director, was diagnosed with prostate cancer earlier this year. Even after the passage of the Affordable Care Act, his insurance company delayed and denied cancer treatments despite MacDougall paying his premiums. This is his story, in his own words, written five days before he died.

How far will a health-insurance company go to deny coverage when you are really sick?

How willing are they to risk their customers’ health and possibly their lives? Well let me tell you my experience with Health Republic and its affiliate MagnaCare.

For five months—ever since I was diagnosed with stage-four metastasized prostate cancer—they refused to pay my medical bills. On Oct. 20, a nurse with Health Republic overruled my oncologist and my primary-care physician and declared that a critical test to determine the progress of my cancer was unnecessary.

It seems she was wrong. As a result, I am writing this from Lenox Hill Hospital, where I am undergoing emergency tests and treatments ordered by three prominent New York doctors who didn’t agree with that health-insurance nurse.

This latest fiasco is not at all surprising. I have been fighting to get Health Republic and MagnaCare to explain why they suddenly and inexplicably refused to pay for my doctors and my treatments even though I followed their rules for members, went to their online list of providers, and actually received two form letters stating the treatments the doctors had ordered were legitimate.

It’s a long story, but if you want to know what it’s like dealing with the health-insurance bureaucracy when it’s a matter of life and death, you might want to stick with me.

My health-insurance company has refused to explain why, on every visit, these doctors accepted my Health Republic/MagnaCare card, and assured me I was “in network”… or why the doctors I saw appeared in the insurance company’s website of providers… or why they sent me two letters assuring me that my treatments “meet criteria and have been certified”… or why they waited five long, costly months to tell me that my doctors were not “in network.”

Bottom Line: They won’t pay. Period. So don’t ask.

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But of course, I kept asking. Because cancer treatments are very expensive and I know that I followed the rules every step of the way. I have always tried to be nice when I ask why they won’t pay because I know better than to seem angry when dealing with tight-jawed insurance people.

But being nice hasn’t helped me make sense of the bizarre, nonsensical reasons my insurance company has used to try to explain why they won’t pay. This is a case where delay is denial—with potentially deadly results.

For example, when I asked the broker who sold the policy why my primary-care physician, Dr. David McIntosh, appears on the MagnaCare website listing in-network providers, he explained that I had used “the wrong code.” He said I had used the “099 code” instead of he “699 code.” Apparently, it is a very secret code because it had never been given to me. Subject closed.

When I asked the Health Republic customer-service phone line representative why all the doctors I saw readily accepted my Health Republic/MagnaCare insurance card, she said my particular network was “MagnaCare Extra” not just MagnaCare. When I pointed out that my card simply used the name “MagnaCare” and that I had never heard of “MagnaCare Extra,” she said that was “too bad.” Subject closed.

When I asked why Health Republic had sent me two letters stating, “The request for services meets criteria and has been certified,” the representative said firmly, “we will get back to you on that.” No one has gotten back to me on that.

And when I asked why they had waited five months to inform me that I was not covered for necessary cancer tests and treatments the only answer was, “We can’t possibly inform all of our customers when things like this happen.”

Written by: with commentary by an unnamed other – continue at THE DAILY BEAST

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