Mother's Long Term Care Insurance Company Giving Me the Run Around

[HenryD]

I am stressed and depressed about all this and don't know what else to do. The lawyer says we could take them to court but no guarantees and it will be costly. I have appealed the original determination but have heard nothing.

I am so sorry to read this. Who is the appeal with - this insurance co itself or a state entity?

 

[SecondCor521]

The Attorney General in your Mom's state *might* show an interest if there is a trend of multiple people being affected.

 

[Jerry1]

Does the insurance company give any specifics on the reason for the denial? As part of an appeal, I would ask for specifics.

What did the Department of Insurance say about this?

It doesn’t seem that they could issue a denial without specifying the contract terms that your mother is not meeting. The absence of specificity would be what I’d be discussing with the Department of Insurance.

 

[Koolau]

When my mom went to memory care, the insurance company sent a few forms and her doctor had to sign off on some things. I think checks started rolling in after about a month. There was one lady I always called and spoke with about any issues. She even suggest mom could qualify for the benefit again if she went home, paid premiums for 6 months and then returned to a nursing facility. Of course, that wasn't possible, but I didn't solicit that info. The nice lady (Joy!) handled just about everything and was most pleasant and helpful.

I'm so sorry harllee that you are being treated so shamefully. Blessings and aloha.

 

[harllee]

That’s really awful Harlee!! A few of my friends that are close to 80 are cashing their policies out because the rates are going up so much. So I guess the question is which option is cheaper for her out of pocket at this point to decide if she stays where she is or goes to memory care.

Her policy does not have a cash out option, if it did I would probably be doing that. She may not be able to stay in independent living much longer because the CCRC is saying it is not safe for her to be in independent and she really does not qualify

 

[harllee]

I am so sorry to read this. Who is the appeal with - this insurance co itself or a state entity?

The appeal is with the insurance company. The NC Dept of Insurance is really not interested because MetLife is no longer selling long term care policies.

 

[harllee]

Does the insurance company give any specifics on the reason for the denial? As part of an appeal, I would ask for specifics.

What did the Department of Insurance say about this?

It doesn’t seem that they could issue a denial without specifying the contract terms that your mother is not meeting. The absence of specificity would be what I’d be discussing with the Department of Insurance.

As far as I can tell the denial is based because they say she can do ADLs but she cannot. They have never been to visit her in person. I think it is just an arbitrary denial, the consultant says that is what most all long term care insurance companies are doing these days.

 

[Jerry1]

As far as I can tell the denial is based because they say she can do ADLs but she cannot. They have never been to visit her in person. I think it is just an arbitrary denial, the consultant says that is what most all long term care insurance companies are doing these days.

I think I’d get a second doctor to confirm that she cannot do the ADLs and include that with the appeal.

 

[harllee]

I think I’d get a second doctor to confirm that she cannot do the ADLs and include that with the appeal.

I actually have sent the insurance company 3 doctors statements that she cannot do ADLs--her gp, her neurologist and the doctor at her CCRC. All that was included in the initial application and the appeal.

 

[badatmath]

I don't have any suggestions just sympathy.

 

[whatnot]

It is so frustrating that an insurance company can get away with these games! Especially, when the family is already having to deal with an ill loved one.
It is down right negligence and borderline fraud!

 

[badatmath]

Have you got a formal letter from the department of insurance that the investigation is completed?

 

[harllee]

Have you got a formal letter from the department of insurance that the investigation is completed?

No investigation was done since the company no longer sales LTC products in NC

 

[Buckeye]

Local TV station troubleshooter?

 

[Jerry1]

No investigation was done since the company no longer sales LTC products in NC

This seem unbelievable but I guess it might make sense that there’s nothing they can do if the insurance isn’t being sold anymore.

Time to contact your Attorney General and your state representative.

Ugh - what a mess. I’m sorry you’re going through this.

 

[MrEd]

I second the attorney general.

 

[Texas Proud]

I will give sympathy....


One thing that my sister said about helping out in things for daily living...



Say you put underwear down on the floor and the person can step into the holes... but cannot reach down and pull them up... that qualifies as being able to 'help' in getting dressed... but my sister said you are still standing there naked and cannot do anything about it..


The rules are really bad at times... I remember my sister insisting that the facility where my mom was staying change what they had on a report as it was false... they said they would later.. but sis said NOW.. she knew it was not going to be changed and they were covering their butt on her care..


She also said ALL facilities around here were not good... we just had to find one that was not as bad as others... fortunately I was able to do so..

 

[badatmath]

It is really depressing that us or our loved ones end up in such a state.

 

[youbet]

Harlee…..


Do you think Met Life would approve the claim if your DM moved into the memory care unit instead of remaining in her independent living apartment with aides helping her there?

 

[harllee]

Harlee…..


Do you think Met Life would approve the claim if your DM moved into the memory care unit instead of remaining in her independent living apartment with aides helping her there?

Possibly-- but memory care will cost $12,000 per month, and the LTC insurance will only pay about half of that so we were trying to delay that move. Right now it is costing much less to the family to keep her in independent living with help morning and evenings. The LTC insurance specifically says it will pay for home health care.

 

[sheehs1]

Oh Harlee..you have have my very deepest sympathy! This is just NOT right! What you have described is the main reason I decided to "Self Insure". I did not think my daughter would be able to navigate the paper work, the red tape much less when the insurance company denied coverage. Correction, I knew she would not!
Your sweet Mother is fortunate to have both you and your sister. I hope some time you are able to get what your Mother deserves for her LTC payments all these years.

 

[harllee]

Thanks for all the kind words. One of the worst things is that I am spending all these hours on the LTC insurance that I would otherwise be able to spend with my dear mother. I am glad that mother does not know how much trouble I am having with the insurance company--she would be very upset. She was always so proud that she had long term care insurance

 

[Koolau]

That’s really awful Harlee!! A few of my friends that are close to 80 are cashing their policies out because the rates are going up so much. So I guess the question is which option is cheaper for her out of pocket at this point to decide if she stays where she is or goes to memory care.

Teacher Terry, how does one cash out a policy? I've never heard of that. I might just be interested if there are advantages - other than not paying premiums. Thanks.

 

[harllee]

OP here with an update. Mother finally got her first payment yesterday from her LTC insurance company in the amount of $24,000. It took me 6 months of blood sweat and tears to get this payment. I filed many papers, called the company at least twice a week, appealed her denial, filed a complaint with the state insurance department, hired an expensive consultant, hired an attorney, wrote the company CEO and got AARP involved. I don't know what finally did it but the money showed up in her account yesterday. This has been one of the most frustrating experiences in my life. It is now set up from her CCRC to file a claim every month for her expenses, I hope that will got more smoothly.

I bet many families just give up and never get paid by the LTC insurance, I am sure that is what the company hoped I would do.

 

[MichaelB]

OP here with an update. Mother finally got her first payment yesterday from her LTC insurance company in the amount of $24,000. It took me 6 months of blood sweat and tears to get this payment. I filed many papers, called the company at least twice a week, appealed her denial, filed a complaint with the state insurance department, hired an expensive consultant, hired an attorney, wrote the company CEO and got AARP involved. I don't know what finally did it but the money showed up in her account yesterday. This has been one of the most frustrating experiences in my life. It is now set up from her CCRC to file a claim every month for her expenses, I hope that will got more smoothly.

I bet many families just give up and never get paid by the LTC insurance, I am sure that is what the company hoped I would do.

Well done, M’lady.