Classical HMO

When the heroes of Ancient Greece apply for healthcare reimbursement, the results can be tragic.



Daniel Mendelsohn
November 30, 2001 12:29AM (UTC)

Dear (Ms.) Thetis:

We are writing to you in reply to your application for death benefits following the untimely passing of your son. We have carefully reviewed the case of ACHILLES (NO SURNAME GIVEN), and regret to inform you that we are unable to pay any benefit at this time.

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According to the records you provided, your son died of an arrow wound to the heel while covered by The Plan. However, the medical records you provided indicate that his heel condition was, if not congenital, then present almost from birth -- the result, moreover, of a non-covered home treatment of your own devising. The underlying cause of your son's death is, therefore, deemed to be a pre-existing condition, and hence not covered.

With sincere condolences on your loss,

L.A. Chesis
Senior Claims Coordinator

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Dear Mr. Rex:

We regret to inform you that your application for benefits related to your recent blindness has been rejected by our Claims Department.

As I'm sure you are aware, your FreeWill™ Contract specifies that benefits of any kind are not payable when the Covered Party's injuries are self-inflicted. For the same reason, the Dependent Death Benefit you inquired about in the case of the passing of your Co-insured is not payable, either.*

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With sincere condolences for the recent tragic events,

Mo Ira
Assistant Claims Adjuster

*We were unable to ascertain from your letter whether the "Mrs. Rex" referred to therein was your wife or your mother; the former would be covered automatically, but not the latter.

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Dear Ms. Daphne:

Please forgive our tardiness in replying to your letter of last Arbor Day. I'm afraid it was rather difficult to read.

Although your LibertyPlan™ contract does in fact cover most known varieties of arthritis, I'm sure you'll agree that your case is a most unusual one. Indeed, careful review of The Plan will make it clear that Covered Health Costs only apply in cases where the Claimant is human. I regret to reform you that in your case, this means that Coverage ended at the moment you turned into a tree.

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I am so sorry we are unable to help you. On a more personal note, may I suggest plenty of sunshine and lots of fluids?

With all good wishes for the Holidays,

C. Lotho
Administrative Assistant to Ms. Chesis

P.S. For reasons of professional ethics, we are unable to accept the kind enclosure of the fragrant homemade wreath, which we are returning herewith.

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Dear Mr. Prometheus:

As Claims Coordinator here at OlympianCare™, I've reviewed a great many claims for cases of hepatitis and cirrhosis, but your recent claim was a first, I must say!

Unusual as it is, a condition as grave as yours would, typically, still be considered to be covered under your Unlimited LibertyPlan™. However, since you mention that the organ in question in fact grows back each day, I'm sure you'll agree with us that no treatment is necessary, and hence that your claim is not valid.

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With all best wishes,

A. Tropos

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Dear Mr. Phemus (after so many years of correspondence, may I just call you "Poly"?):

I am happy to report that your application for coverage of expenses related to your recent injury as been approved by our Claims Department.

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Indeed, in addition to covering the cost of the prosthetic Device you now require, as covered by your Plan, we are paying you the Benefit normally payable in cases of Total Blindness, even though you lost only one eye in the incident you mention. Hence you will receive the full 50 head of sheep instead of 25. Payment will be delivered as soon as the voucher has been processed. Does your island have General Delivery, or is there a street address?

I am afraid, however, that there is very little we can do about the slowness with which your prescription is being filled, as mentioned in your note. It is no doubt difficult to find, or manufacture, glass eyes in your size.

With all good wishes,

E.U. Tuchia
Distributions Coordinator


Daniel Mendelsohn

Daniel Mendelsohn, the author of a memoir, "The Elusive Embrace: Desire and the Riddle of Identity," is the book critic for New York magazine.

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