'We feel we can breathe again': Blue Cross reverses course, will cover Sask. man's $500K medical bills

Saskatchewan Blue Cross has had a sudden change of heart.

The family of Louis Lamothe, 72, the Halbrite, Sask. man who suffered a stroke while vacationing in Arizona, had to pay $56,000 for medical his flight home and was facing thousands in expected bills from U.S. hospitals when their travel insurance claim was denied.

On Thursday evening, the family says, the insurance company informed them that they will cover all expenses.

"We feel like we can breathe again," Lamothe's granddaughter, Rebecca Fee, told CBC News. "There are finally some smiles.

"It's just a huge sense of relief that Blue Cross reversed its decision. They didn't give us a reason why they changed their minds, but I don't need that reason as long as they cover it."

Fee suspects the national media coverage was a reason for the sudden reversal, but said the insurance company "declined that as a reason." She said Blue Cross, who is in consultation with the U.S. hospitals, informed them on Friday afternoon that their hospital fees are "more than half million Canadian dollars."

In a Friday morning email exchange, Saskatchewan Blue Cross declined an interview but confirmed that the situation had reached a conclusion through their standard claim management process.

"As with all claims and claims decisions, privacy requirements prohibit us from sharing specific details," the statement said.

The letter Blue Cross sent to the family on Thursday evening says the insurer, after reviewing the family's claim, accepted "the expenses related to the emergency medical services" received in Arizona for the period from Feb. 3 to Feb. 26, 2023.

"They are covering his hospital bills from Yuma and Phoenix, his medical flight home and offered $500 for extra expenses, which of course were close to $10,000," Fee said.

"They are even transporting his truck from Yuma, Arizona to home. We'll see what else they can do for us after this very very long month. I'm glad they took responsibility for this."

Fee says the claim should not have been denied in the first place. She said the insurance company had argued it was because Lamothe failed to disclose a change in the dosage of cholesterol medication he had been taking.

Lamothe had been on a 10-milligram pill, which was increased to a 20-milligrams in July, three months before he left for the U.S. Because Blue Cross had not been informed of the dosage increase, the family said, Blue Cross declined to insure Lamothe for his hospital stay or flight home.

Fee said her grandmother, Arlene Lamothe, who told CBC on Monday that the predicament would have meant her selling her house in Halbrite, was "screaming, hugging and crying" upon learning the news.

The family said a pro bono lawyer from Toronto, in an unofficial capacity, is also helping them out. Fee says she has 54 pages and multiple documents to review, and has to submit all their expense receipts to Blue Cross for reimbursement.

"They specifically stated that my grandpa is the person who has to sign the paperwork. How does he do that when he is paralyzed on the left side and he is left-handed?" she said.

"I've to find his power-of-attorney paperwork and have a full two days of paperwork ahead, but the end is in sight."

Now, Fee says, he family wants to focus all their energy on Lamothe's recovery.

"Long road to recovery"

Lamothe is in stable condition, but still relies on a feeding tube. Fee says her grandfather has been been able to get into a medical chair a few times with the help of health-care workers at Regina General Hospital..

"He definitely has a long road to recovery and rehab. He can say some words now but even to see him try to speak is a miracle," she said.

Fee advises others to triple check medication and health records before travelling: Reading the fine print is vital before purchasing a travel insurance.

She is thankful to Blue Cross who would be directly contacting the two Arizona hospitals on Friday for the bills, and will send a cheque to the family reimbursing for the medical travel.

"I am thankful to family and friends and strangers who helped us and donated to our GoFundMe page," Fee said, noting all donors told them to keep the money when family tried to return the donations.

"Even our local fundraiser here in Estevan [Sask.] will keep it going to help my grandma. It's overwhelming to see such support pouring in."

Fee says it could take up to a year for her grandfather to recover.

The ordeal took an emotional toll on her personal family, too, as she left her three kids home with her husband for almost a month while she was helping her parents in Arizona.

"My grandpa was an avid gardener. Immediately after he is recovered — whether it's at our house or his or outside a nursing home, if he ends up there —  I want to build him a raised garden bed," she said.

"I don't want him to ever not garden again. Whether it is from his medical chair or if he regains his strength, I want him to keep continuing it. But for now, we hope he comes home soon."