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

[REWahoo]

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.

Congratulations! Very glad to hear you held their feet to the fire until they honored their agreement.

 

[sheehs1]

Congratulations and many claps and kudos to you for sticking with it and hounding them.
Please Let us know how the subsequent months go!

 

[N02L84ER]

Great news. I am sure you are very relieved.

 

[lucky penny]

Wonderful news, harllee. It seemed clear your mother was entitled to the coverage. Is the payment retroactive?

 

[Jerry1]

Well done, M’lady.

Definitely. Good going.

 

[SecondCor521]

Even though your Mom might never realize or understand or say it, I think she would be and should be very proud of your hard work and appreciate the efforts you made for her. Good job.

 

[Aerides]

Wow Harllee that is quite a win - finally - after your tremendous efforts.

 

[MarieIG]

Great work Harlee!

 

[bevette]

That’s wonderful news Harlee. All thanks to your determination.

 

[harllee]

Wonderful news, harllee. It seemed clear your mother was entitled to the coverage. Is the payment retroactive?

Yes, it is retroactive going back over 6 months, total around $25,000 plus $3000 premium refund (policy had premium waiver that said premium stopped when she qualified for coverage). But no interest on what they owed.

 

[lucky penny]

Yes, it is retroactive going back over 6 months, total around $25,000 plus $3000 premium refund (policy had premium waiver that said premium stopped when she qualified for coverage). But no interest on what they owed.

This is such great news. Your mother is very lucky to have you fighting for her since it seemed they were stonewalling. You mentioned you had hired an expert to help with this; do you think that made a difference?

And you no longer owe premiums once coverage kicks in?

 

[RetiredHappy]

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.

Thank you very much for the update! I am glad this is finally resolved. Their refusal should never have happened in the first place. I would still hold the CCRC primarily responsible for not getting to the LTCI company everything that it needed to get the approval in the first place. When we ran our business, we got weekly sheet which checked off daily ADLs which were performed by the home care aides as part of the submittal, signed by client/rep of client and home care aides. Then of course, MetLife was playing dirty in your mother's case. When we worked with MetLife and Prudential separately, we never had issue either.

 

[Texas Proud]

Glad you got payment... and back premiums...


But did you get your expensive professional and attorney fees? I think they should have to pay for them also...

 

[harllee]

This is such great news. Your mother is very lucky to have you fighting for her since it seemed they were stonewalling. You mentioned you had hired an expert to help with this; do you think that made a difference?

And you no longer owe premiums once coverage kicks in?

I hired the expert for a couple hours to help me with the appeal of denial, $150 per hour. They did give me some suggested language that probably helped but I did all the work, took me many hours. I also hired an attorney to write a demand letter ($300 per hour), that probably helped more.

What might have helped the most is AARP--they contacted the insurer on my mother's behalf.

Mother's policy had a premium waiver provision that states premiums cease once the claim starts paying. They owe mother 6 months in back premiums, I have not gotten that check yet.

 

[harllee]

Thank you very much for the update! I am glad this is finally resolved. Their refusal should never have happened in the first place. I would still hold the CCRC primarily responsible for not getting to the LTCI company everything that it needed to get the approval in the first place. When we ran our business, we got weekly sheet which checked off daily ADLs which were performed by the home care aides as part of the submittal, signed by client/rep of client and home care aides. Then of course, MetLife was playing dirty in your mother's case. When we worked with MetLife and Prudential separately, we never had issue either.

I think the CCRC did all they could--they sent the correct things to the insurer but then the insurer claimed they "lost" everything on 2 different occasions and all had to be resent. Infuriating. Then the insurer ignored everything and denied the claim anyway.

 

[harllee]

Glad you got payment... and back premiums...


But did you get your expensive professional and attorney fees? I think they should have to pay for them also...

No reimbursement of the fees, around $2000. I don't know how I would go abut getting that reimbursed.

 

[whatnot]

Great news.
Insurance companies should be held to account for their delay tactics.
So frustrating for families and patients who have paid for insurance and then must fight to receive benefits!

 

[Exchme]

I first saw this thread a few months ago, about the time MIL was claiming on her LTC policy and used harllee's experience to warn the folks that were there about the potential pitfalls. I told them about the LTC company trick of "losing" the paperwork, so they should very carefully get all the documentation, photocopy everything, get a return receipt on the mail, promptly follow-up to ensure everything was received, etc.

It all worked for MIL, so rest assured, harllee, sharing this insurance horror story helped others. Thanks much!

 

[athena53]

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.

That's really disgusting. I thought the regulators were supposed to protect consumers- period. Why should it matter if they're not selling that type of coverage in the state anymore? (And the insurer probably knew the regulators wouldn't get involved. )

Congratulations on getting results from your hard work.

 

[harllee]

After all this-- I think Long term care insurance is a a terrible product, especially if you live to an old age (which is when most people need the coverage). In mother's case it was very difficult to get them to pay even though she obviously qualified--has Alzheimers and heart failure. She took the policy out in 1986, has paid ever increasing premiums ever since. It is a 3 year policy-- I computed the max the policy will pay and what she had paid in premiums over the years--she would have been substantially better off if she had put the premium money in a CD.

 

[pacergal]

harlee--great news and determination on your part to get what your mom deserved and paid for.
Congratulations. It is too bad it took so long and so much time, energy, other. finances to get to this point.
Your last note is something we considered and went with. My work offered (sort of) low cost LTC insurance years ago, but I just didn't see the benefit. We simply increased our deferred comp to save more for our care in the future, if needed.

 

[Chuckanut]

Harley, you are an inspiration to many people here.

 

[SecondCor521]

No reimbursement of the fees, around $2000. I don't know how I would go abut getting that reimbursed.

You could consider suing the insurer in small claims court. There are multiple reasons this wouldn't be a great idea, though. First, time/cost/effort of suing. Second, you might lose. Third, your mother's state law might not allow for recovery of the fees. Fourth, your mother might not live in the same state, which would mean it would involve travel hassle. Fifth, it might just be too much aggravation and emotional stress over too little money.

You could ask politely, but we all know how that would turn out.

That's really disgusting. I thought the regulators were supposed to protect consumers- period. Why should it matter if they're not selling that type of coverage in the state anymore? (And the insurer probably knew the regulators wouldn't get involved. )

I've complained to my state regulators a few times. They do nothing. IME, YMMV.

It is a 3 year policy-- I computed the max the policy will pay and what she had paid in premiums over the years--she would have been substantially better off if she had put the premium money in a CD.

The insurance companies themselves usually invest in a broad combination of conservative investments, and they stay in business. So it's not surprising that their payouts, on average, are not that great. Your analysis doesn't even account for all the people who give up, or don't accrue the policy max because they don't need it, or die before the three years are up.

No shade on the insurance companies, but all of this contributes to why I self insure for as much as I possibly can. I have no LTC, high deductible health and home, and high liability on auto. My premiums are invested in the market, and have been for the past several decades. This strategy also motivates me, in addition to any other intrinsic motivation, to take care of my health as best I can.

 

[carlight]

So glad to hear that you were able to get what your mom deserved!

 

[Koolau]

I'm so glad things are starting to go your way. Now that you're in the habit of writing to the insurance company, I'd be submitting claims for 1) the waiver of premiums AND 2) the professional fees. I'd threaten them with informing FIRE Forum (heh, heh, we already know, but that might scare them as much as AARP!)


Blessings on you and your mom! Keep us posted on further developments.