Shock of son’s $300,000 hospital bill
The family of a seriously ill man facing at least $300,000 in hospital bills claim his insurance company should have been more open about what his health plan covered.
Dandre Outerbridge thought his Standard Health Benefit plan covered overseas medical care, until he found himself at Mount Sinai Medical Centre in Miami Beach, Florida, with a diagnosis of viral encephalitis — a form of meningitis that affects the central nervous system.
The 27-year-old Corcon employee started developing symptoms in Bermuda, but fell seriously ill three weeks ago while on holiday in Florida with friends.
Soon after arriving at his bedside, Mr Outerbridge’s parents, Jeanna Scott and Andre Woods, learnt that his SHB plan at Argus did not offer overseas medical coverage.
Ms Scott was shocked. Previously, Mr Outerbridge was on the Health Insurance Plan.
“I remember he called me and said ‘mom I have to change my insurance’,” Ms Scott said.
Mr Outerbridge thought his coverage would be the equivalent of HIP.
“If you get sent to an emergency department overseas, HIP covers 75 per cent of that,” Ms Scott said. “We have come to find out that Argus is selling a stand-alone package that only covers local hospital services.”
But according to Argus, the package complies with the Bermuda Health Insurance Act of 1970.
“Argus cannot provide comment on specific cases due to regulatory privacy requirements,” a spokesman at Argus said.
“However, all cases are reviewed individually, and we provide patient advocacy services to any Argus member or their family regardless of level of coverage.
“In cases where overseas care is not provided for, this would include negotiating discounts with overseas providers, assisting members and their families in understanding the medical services they are receiving and co-ordinating care upon the member’s return to Bermuda.
“Employers are legally required to provide their full-time employees with the SHB, which does not include any overseas care.”
The spokesman said Argus actively worked with employers to help them understand their level of coverage and strongly encouraged them to choose plans with full health benefits that extended beyond the minimum.
“We offer options that enable employers to meet statutory requirements while providing flexibility to fit each company’s circumstances, which includes providing SHB-only coverage,” the spokesman added. Argus said a client on SHB could always pay for supplemental insurance to cover any “gaps”.
But Mr Outerbridge’s parents are questioning if it was ever made clear to their son that he was not covered overseas. They have asked him in his more lucid moments, and he said that he did not know.
They have asked Corcon for the information he was given before signing, but had not received it by press time.
Ms Scott said Argus offered to bring her son back to Bermuda by air ambulance, but she was not impressed.
“What would that accomplish,” she said.
When questioned about the air ambulance offer, Argus said they could not legally comment on individual cases.
Ms Scott did not think that King Edward VII Memorial Hospital had the capabilities to get Mr Outerbridge back to health, or rehabilitate him afterwards.
A spokesman at the Bermuda Hospitals Board said it would decide whether it could treat someone with Mr Outerbridge’s condition, or send them overseas, on a case-by-case basis.
The description of the SHB on the Argus website outlines the benefits of the plan but makes no mention of not covering overseas medical care.
The Bermuda Health Council website also includes information about the SHB and a short video about the benefits, but again, does not mention the lack of overseas medical care.
Ricky Brathwaite, acting chief executive at the Bermuda Health Council, said portability was removed from the SHB several years ago.
“Coverage does not extend outside of Bermuda,” he said.
“That has been a longstanding thing through multiple governments.”
He said it was one of the reasons the Bermuda Health Plan 2020 had been proposed, to fill in some of the gaps. He said there had been concern about the adequacy of the SHB.
“Part of the process has been how do we redesign it to cover the true basic needs of the population,” he said.
As to whether he would consider putting a line in the information on the Bermuda Health Council website, about the lack of overseas medical coverage for the SHB, he said it was written in the legislation.
“We try to be transparent in all things on the website,” he said. “We are always open and accessible.”
He said the Bermuda Health Council advocated for fair treatment of everyone.
Mr Outerbridge has been on a ventilator at Mount Sinai and is being treated with a spectrum of antibiotics. The cause of the virus is unknown.
“It just has to work its way out of his system,” his mother said.
So far, friends have raised $20,000 for Mr Outerbridge’s treatment through a GoFundMe page, but said it was not nearly enough.
“It’s just a drop in the bucket,” said Bertie Horsfield who set up the page with several friends. “Of course, anything helps.”
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