ESTEVAN - A southeast Saskatchewan family continues to face some large expenses after a medical emergency in the U.S. that won’t be covered by insurance.
Rebecca Fee of Estevan said her grandfather Louis Lamothe, who resides in the Halbrite area, had a stroke on Feb. 3 in Yuma, Ariz., and spent more than three weeks in Arizona. By Friday morning, he was in stable condition, and he had been medically cleared to fly home once the family could finish arranging a medical flight and secure a hospital bed for him in Saskatchewan.
He flew back to Saskatchewan on Monday and was resting comfortably at Regina General Hospital, Fee said in a post on a GoFundMe page she created.
“His stroke has left him paralyzed on the left side, unable to speak, and unable to swallow. He has extensive rehabilitation ahead of him in Regina … which is an hour and a half from their hometown,” Fee wrote.
Their insurance request through Saskatchewan Blue Cross was denied.
On the GoFundMe page, Fee said her grandfather answered questions truthfully on his application.
Fee noted the insurance company decided they are not covering the Lamothes because, at some point, his cholesterol medication changed from 10 to 20 milligrams.
“We don’t know when, and we don’t even think he knew this as he answered all questions very truthfully, or so he thought,” Fee wrote. “This is something to be aware of. It caused an immediate cut off of insurance, and had my grandma [Arlene] been on the same policy as him, hers would have been cancelled immediately too.”
Louis has had a heart attack in the past and has COPD, but Fee said that information was included in the application.
Arlene didn’t know about the dosage change, either, Fee said.
This was the first time the Lamothes have gone through Blue Cross.
“I don’t know how we can prove that he didn’t know this, and was answering those questions truthfully and honestly,” said Fee.
Fee said it took 15 days after Louis’ stroke for Blue Cross to notify the family his claim wouldn’t be covered.
“They [Blue Cross] needed to gather documents from his family doctor back home, and they had to communicate with the hospital here, they had to communicate with us to ask about all his prescriptions and stuff like that, so I guess it’s a long process, but I think 15 days was a very long time to put him in one of the most expensive hospitals in Phoenix,” said Fee.
In an email to the Mercury, Cheryl de Villiers, the director for marketing and external affairs for Saskatchewan Blue Cross, said they remain confident in the handling of the Lamothe claim overall.
“Privacy requirements prohibit us from providing specific details about the claim and claim decisions. All decisions undergo a formal review with multiple stages involving both internal and external experts including medical care providers,” she said.
“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.”
Travel insurance is essential, she said, 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 people update their 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,” she said.
Fee was able to drive to Arizona on Feb. 6 to be with her grandmother to help her through this time. For the most part, she has been the only family down there. Louis’ brother came for a few days as well.
Fee and her grandmother stayed in hotels in Phoenix to be near him. They have sold the Lamothe’s fifth wheel in Yuma, and sat in the intensive care unit every day for 12 hours a day, praying he would get better, Fee said.
Because insurance rejected their case, they were responsible for paying upfront for his medical flight home through an Ontario-based organization named Angels of Flight. It cost C$56,435, but Fee said the organization has been a big help.
She started communicating with Angels of Flight a little more than a week ago.
“They’re very fast to answer the phone,” said Fee. “They were immediately in contact with the hospital as soon as we filled out the paperwork. We’re staying in hotels, so I’ve had limited access to computers and printers, but we managed to figure it all out to get them the paperwork.”
The cost covered flight and crew member expenses, fuel, permits, state approvals, pre-flight medical assessment, ground transport from facilities, communication and more. Angels of Flight also co-ordinated everything for the transfer.
“They … provide air ambulance, ground transportation, gather his medical reports, provide the medical team for the transport, and do all communication required between all the hospitals and/or the rehab facility,” said Fee.
Fee noted they had little help from the hospital administration in Arizona. They were told multiple times they would have a case manager at the hospital to help deal with this, and after more than 25 attempts to try to call them, they got through twice only to be told they would get a call back. Fee said it didn’t happen.
She pointed out the nurses and doctors in Arizona were absolutely outstanding and went above and beyond for the family.
Louis gets confused sometimes, Fee said, which might be due to the swelling and the brain fluctuation. He sleeps a lot during the day and has constant migraines.
As of Wednesday afternoon, the campaign, Please Help us Return Louis Lamothe to Canada, had raised $25,933 of its $100,000 goal, with 312 donors. The funds would be used to help pay for the flight and the three-week ICU bill. She expects the total bill will be at least $100,000, with multiple CT scans, chest x-rays, ultrasounds, intubation tube and more.
“I know they have a lot of medical bills ahead of them, on top of this medical flight, so any help we can get is great,” said Fee.
She plans on reaching out to the Kinsmen Telemiracle Foundation to see if they’re eligible for support, and they’re looking for other avenues.
“We have a lot of great friends and family that have started helping to pitch in,” said Fee.
