UPDATE: After posting this on March 7th the same investigator who called the week before phoned back on March 8th to say that she had reversed her decision. Thank you thank you thank you to everyone who emailed Manulife, tweeted and posted on Facebook. You have my eternal gratitude.
- On November 16th I had a major operation and was hospitalized for 10 days.
- Manulife Insurance is refusing to pay my $2,790 hospital bill.
- My partner Blair is a carpenter at a major public employer in Toronto. Manulife’s semiprivate hospital coverage is a benefit included in his collective agreement.
- We phoned Manulife on November 7th to confirm we had 100% coverage.
- We received the results from a Manulife investigator on Thursday March 2nd that they had investigated themselves and determined that they do not have to pay this bill.
- The Benefits Officer who bargains on behalf of Blair’s employer worked at Manulife for many years before becoming management at his employer and will not advocate for us.
Many would point out that a semiprivate hospital room is a privilege and not a right.
And if I hadn’t been advised by a Manulife customer service representative nine days before my surgery in November that I had 100% coverage for private and semiprivate rooms, I would not have opted for one. During roughly a dozen other hospitalizations in the last fifteen years I have forgone this privilege and stayed in four-bed ward rooms with the knowledge that anything else is far too expensive.
In fact, in the middle of this dispute with Manulife in January, I spent the weekend in a ward while recovering from a bowel obstruction. I endured three other patients and their many visitors, including the creepy adult daughter of the elderly woman across from me sitting in a chair at the foot of my bed, staring at me. She was in her mid-fifties with implausibly blonde hair and a menacing grin. I had a nasal gastric (NG) tube attaching the inside of my stomach to suction on the wall. A couple of times, in addition to stomach bile, that tube filled with blood. It was one of these times where my attendant nurse was adjusting the tube that this woman gazed at me with what I imagine she considered a sympathetic smile but all I could see was Children of the Corn.
I am not exaggerating when I say that I still have nightmares about other people’s visitors sitting on my bed while I am hooked up to suction. Or the patient next to me slamming into my IV pole as revenge for my nurse brushing past hers, and the sensation as it hits my NG tube. Just writing that activates my choke-gag reflex—the somatic memory of the tube, and my glands swelling and tightening as it scrapes my throat is still fresh.
To be clear, I don’t think anyone should ever have to stay in a ward room. Every doctor and nurse who visited me communicated this without any prompting from me. The nurse who was there for the “smile” rushed to pull my curtain tightly between my bed and this woman, glaring as she told her to move her chair.
But Manulife would say none of this context matters. They are not in the business of determining who deserves what ethically, humanly, or medically. We have other systems in place for such decisions. Their only role is to determine whether my partner had checked the box on his insurance form enrolling us in this coverage.
Neither Blair nor I had heard of any such box until six weeks into the “investigation” between his employer and Manulife. Finally at that point, when he appeared in the benefits office at his work uninvited, they produced a form that he had signed acknowledging his health plan with an unchecked box for “semiprivate hospital” coverage. Given that the employer pays for the health plan, nobody would knowingly decline such coverage.
Such “check boxes” exist to reduce costs for employers and insurance carriers. Employers offer this coverage in collective bargaining with one hand and receive discounts from Manulife by effectively denying employees coverage with the other. Then, employers outsource their human resources department (HR) to Manulife so they can avoid answering inconvenient employee questions. Every communication we’ve ever had about Blair’s health plan instructs us to phone Manulife directly with any questions about coverage.
So on November 7th, that’s what we did. The person I spoke to wasn’t sure what my coverage was and asked if she could return my call later in the day. When she phoned back she explained that I had coverage for the “private differential”. I asked what that meant. She went to talk to a manager. I asked if I could speak to the manager. She declined. I asked if it was the difference between what the government paid for ward rooms and what the hospital charged for semiprivate and private rooms. I read out the amounts from the hospital website to be clear. She said I had “100% coverage” for semiprivate and private rooms. I recorded her name and reference number for the call, thanked her, and hung up.
I was in bed a month later when I got the email from Manulife Financial. While in surgical recovery it sometimes took hours to get up in the morning. Blair would bring me breakfast and I would ingest as much as I could so I could tolerate the amount of pain medication required to move. Still, when I saw the subject heading “Your Manulife Claim Has Been Processed” on my phone I wanted to see right away that the coverage was in effect. In pain, and against my better judgment, I opened our Manulife claims account online.
The hospital bill was $2,890. Manulife paid $100. Not 100%. $100.
I began making calls. The Manulife call centre staff and benefits assistant at Blair’s work were all kind and sympathetic. I believe if it were up to them the claim would have been paid. I cannot imagine the context of the call centre and the consequences of getting things wrong. If they are agitating for better conditions they have my solidarity. But I don’t have $2,790 to cover their error. And management at both Manulife and Blair’s work were smug. Cold, unfeeling, and confident they would win this. Their confidence is well-founded. Multi-billion dollar industries almost always win against sick people in what too often become fights to the death.
After two months of persistent agitation we received an audio copy and transcript of the November 7th phone call. It was exactly as I described it. But apparently “private differential” actually means the cost difference between semiprivate and private rooms, a benefit no one could possibly guess they had because no one would want it. The first night after surgery I had a private room, and spent the next eight nights in semiprivate while this happened. $100 covered the one night cost difference between my private and semiprivate room. The difference between ward and semiprivate for the entire nine nights was on us.
The Benefits Officer at Blair’s work has a public LinkedIn page. This is how I know that she worked for Manulife for six years before becoming management at this major public employer in Toronto. In the section where she summarizes her work at Manulife, she highlights the fact that she got large clients to outsource their human resources departments to Manulife. Also during her tenure at Manulife, local call centres were closed and the work of answering calls was outsourced abroad. The distance is a problem for both the caller and the answerer. Manulife call center employees’ night shifts coincide with North American day times.
There will never be enough ways to say that I don’t blame the call centre employee for any of this nonsense. I wish Manulife would pay her more money on better shifts. If I had any power to make that a reality I would use it. I really, really don’t want to get her in trouble. I can only guess that Manulife’s business strategy relies on overworked underpaid workers taking the fall for their super convoluted policies. I have no such qualms about managers or investigators. They are all doing their jobs exactly as they are supposed to. They get rewarded for denying claims keeping costs low.
The week before my surgery Manulife Financial reported a 79.6% rise in quarterly profits raising the net income attributable to shareholders to $1.12 billion. I don’t know how much CEO Donald Guloien made last year, but in 2014 he was compensated $14.5 million for his efforts.
I am writing with the news playing in the background. Manulife is advertising their “flexcare” plan. Lots of happy athletic people doing happy athletic things. Highly consistent with CEO Donald Guloien’s big idea for Manulife: track clients’ fitness levels using devices like Fitbits to offer discounts on insurance for people who can demonstrate good health.
This approach to humans, where our bodies are machines meant to be calibrated to minimize risk, is entirely consistent with every cold interaction I’ve had with Manulife management and investigators in the past few months. Ostensibly, Manulife is measuring people’s health risk, but really, we know the actual concern is profit risk.
This is how Manulife formats their “vision” online:
Real Value to Our Customers
Demonstrated Financial Strength
Employer of Choice
If they fit it into an acrostic poem it must be true. Who wouldn’t take PRIDE in denying benefits to critically ill patients in hospital while wooing more attractive clients on the side?
I keep wanting to talk about my fate being indelibly wedded to CEO Donald Guloien. It’s a stretch, granted. But every time I see his name I think about The Wedding Singer and Drew Barrymore as Julia marrying Glen Gulia and how if I married Donald I would be Julie Guloie(n). But in the end I can’t find the joke.
Because this really is my face right now:
My hair has been falling out for the last six weeks.
I read that this can happen in the months after any kind of trauma. The surgery and its aftermath would certainly count. We like to say that the cats leave “extra cats” in the form of giant balls of fur shed and gathered in corners. Lately I have been leaving “extra Julies” in the shower and on furniture.
I was brushing my hair before showering to avoid this when I got the call from the Manulife investigator on Thursday March 2nd. I instinctively covered myself with a towel before answering, not wanting to talk to her naked. In one hand I held the phone, in the other a clump of hair that had fallen out, squeezing the towel under my arms so it didn’t slip.
She asked for Blair, as they have been ever since this dispute, refusing to speak to me about my own health unless the “policy holder” is present. But she made an exception when I told her he was at work. Blair had just sent an email to her and everyone else involved that if they didn’t respond to us we would go to the press. After ignoring our messages for a week before this email, she called within the hour.
She informed me that she had completed her investigation of her own employer and discovered that they were correct and I was wrong. I wonder exactly which aspect of PRIDE she was enacting when she snort-coughed at my horrified response, was it Professionalism, Integrity, or Real value, to me, the customer?
Their PRIDE relies on the shame, embarrassment, exhaustion of sick people not wanting to rehash the intimate details of the pain Manulife’s policies create. Unfortunately for them, fifteen years of illness has washed my shame clean. And none of my insecurity is attached to my communication or comprehension skills, so they would have some difficulty embarrassing me about “my error”. I have found unexpected reserves of energy to avoid an unjust $2790 bill. They must have spent more than that arguing with me. How embarrassing for them.
In the US, Republicans are now repealing the Affordable Care Act (commonly known as Obamacare). One of the arguments I’ve heard is that people are more cautious about spending their own money than the governments. So ideas like “tax credits” are being floated as alternatives to government-sponsored care. I have a small idea of what that might look like since I became eligible for the Disability Tax Credit here in Canada. In years when I have been well enough to earn a substantive income, the cheques come to me. For other years, the cheque goes to Blair. A consolation prize of sorts. “We’re sorry you hitched yourself to a unproductive economic unit. Here’s some cash for your trouble.” In small and large ways bureaucracies communicate how simultaneously inconsequential and burdensome my existence is.
If we lose this fight with Manulife, once we file our taxes we can just sign our “credit” right over to the hospital and help Manulife out with that $1.12 billion net quarterly earning for shareholders.
This is what it looks like when insurance companies are in charge of our health.
I am lucky, I know. Lucky that I live in Canada where medicine is public and that I have a partner with a good job. That I have accessed enough education to develop verbal reasoning skills. That I am relentless. That I rarely lose conscious awareness while hospitalized so can advocate for and defend myself in ward rooms. That I discover new heights of physical and emotional resilience with every bureaucracy-driven traumatic incursion to my autonomy. Without all of this “luck”, arguably, I could very well be dead.
So there is a bigger philosophical question here too. If modern medicine has the capacity to save our broken and virtually uninsurable bodies, what is society’s responsibility to us afterward? Are we simply risks to be managed? Burdens to be passed off between public and private financiers? Or is there a humane possibility beyond this?