Wednesday, June 14, 2017

Falling through the cracks, CIA-style

This is just a complete tragedy all the way around:

"Former CIA contractor, former SEAL, falls through medical insurance loopholes"

While serving as a contractor for the "CIA’s Global Response Staff in a Middle East outpost," he suddenly began experiencing severe chest pains. But because of his position as a contractor, not an employee, he was shunted off to "a local hospital – and seen by a doctor who did not speak English – who misdiagnosed him simply as having heartburn."

Turns out, it was actually much more serious, and he was eventually sent home - on a commercial flight, no less - where he underwent open heart surgery and other significant health care.

Okay, not ideal, but at least his employer's insurance covered all this, right?

Turns out, not so much:

The Defense Base Act (DBA), on which Mr Wojciechowski relied to pay his medical bills, really isn't set up to do so. In fact, it's basically structured to not cover most, perhaps all, of his care in this situation.

Why is that?

Well, as usual, the MSM can't be bothered to do 10 minutes of research by reaching out to folks who actually, you know, do this for a living, like our good friend Peter Schulteis at Global Underwriters. As usual, Peter was happy to share with me how the DBA works, and what it's designed to do.

The first thing to know is that, at its core, the DBA is Worker's Comp. Nothing more, nothing less. And just as one wouldn't expect a heart attack or liver disease to be covered under WC stateside, the DBA doesn't cover these things either.

That's why employers here offer (or provide) health insurance for employees, to cover their non-WC-related claims. Mr W's employer could have also done so, but instead chose to provide the bare minimum coverage that they were statutorily required to obtain. It's analogous to buying liability insurance on one's car: sure, you can buy the state-mandated minimums, but they're hardly going to be much help when you hit a station wagon full of nuns. This is what’s known as “necessary, but insufficient;” that is, doing the bare minimum to avoid breaking the law, while missing the larger point that that’s just not good enough.

So what would constitute "sufficient" in this case?

Well, as Peter explains it, the current buzzwords in his world are Duty of Care" and "Best Practices." What those really boil down to is treating one's employees with respect, and making sure they have not just the statutory (minimum) level of coverage and access to care. That could include something as simple as a travel medical plan that would cover illnesses and med-evac expenses, as well as accidental death coverage and the like.

On the other hand, it seems to me that Mr W is himself not blameless in this:

"By law of the Defense Base Act (DBA), Wojciechowski assumed his health was covered." [emphasis added]

And we all know what happens when we assume.

In this case, a call to his agent (or a few minutes' web-searching) would have shown him that he was not, in fact, covered for non-work-related medical care, and that such coverage is generally available. Alternatively, he could have checked with his employer to see what options they offered.

And so, Mr Wojciechowski continues to languish in deep physical and financial trouble.
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