Anyone Have a Good Experience using John Hancock Long Term Care insurance?

[John Galt III]

Has anyone had a good experience with actually using John Hancock Long Term Care insurance?

My sister and are are struggling to make use of an LTC policy with John Hancock, for moving our dad into a memory care unit at the Continuing Care Retirement Community in which he lives. He and Mom are currently in an independent living apartment, but Mom is responsible for controlling Dad since his mind is largely gone.

So far we have been disappointed by Hancock, in filing a claim to have visiting aides for Dad, since we spent hours filling out forms and getting medical testing done on Dad, only to be denied, not because of Dad's mental state, but simply because the policy did not cover aides coming into an independent living residence! They could have told us that up front and saved us both lots of aggravation. Unfortunately, the staff at Dad's CCRC appears to be as incompetent as John Hancock, since the staff assured us that aides would be covered.

I've been reading a very long thread about geriatric finances that involves John Hancock LTC which was started by Nords in 2011. I've been reading for hours and am still not done. He had a terrible time with Hancock incompetence and foot dragging, apparently.

So.... any rays of sunshine out there about John Hancock LTC?

Another question : how does one find a competent elderlaw attorney besides internet searching and word of mouth from fellow ccrc residents? I think it might save my sister and I both aggravation and money by spending a few thousand on a 'good' elderlaw attorney, both in handling the ccrc staff and John Hancock. The state is NJ.


Thanks, J G III

 

[joeea]

That's unfortunate. With LTC insurance, it can be hard to understand exactly what is and what isn't covered. We have a policy with Mutual of Omaha - they seem to have fairly clear policy language. Still, I can imagine some situations would be difficult to interpret.

I've been told that it's always best to check in directly with the insurance company before any new procedures, rather than depending on community staff or your own interpretation.

What does your desire to move Dad into the memory care unit have to do with covering aides?

 

[W2R]

My mother's experience with John Hancock LTCI was not encouraging either. Luckily she had a grandson who is a hotshot NYC attorney that eats insurance companies for breakfast, and he stepped in and got them to comply with the contract. If she had been on her own, she would not have seen a dime from them.

I decided to self fund my own LTC.

 

[MRG]

IMHO you know the answer. Get a qualified elder care attorney. How? Not so sure. For my parents, the care facility gave some references. Many families in a care facility are probably good references.

Obviously the State Insurance Commissioner may provide some information.

Part of my career was around the back office's of finance and insurance companies, I can tell you there are different procedures if you are represented by an attorney or not.

With no representation you are passed from bumbling idiot #1, 2,3, 4 and back to #1. It's by design, they want you to go away. None of these idiots can actually help you, they're in your way.

They also know attorneys won't go away that easily. They'll throw up roadblocks until a qualified elder care attorney calls.

Good luck.

 

[John Galt III]

.....
What does your desire to move Dad into the memory care unit have to do with covering aides?

The fiasco of the claim for the aides, in which the ccrc staff and John Hancock were incompetent and sloppy makes me think the same thing will happen when we file a claim for the memory care. And not to muddy the waters, but it is the staff of the ccrc who wants (insists) that Dad move to memory care, due to him not being sufficiently controlled by Mom.

 

[John Galt III]

IMHO you know the answer. Get a qualified elder care attorney. How? Not so sure. For my parents, the care facility gave some references. Many families in a care facility are probably good references.

Obviously the State Insurance Commissioner may provide some information.

Part of my career was around the back office's of finance and insurance companies, I can tell you there are different procedures if you are represented by an attorney or not.

With no representation you are passed from bumbling idiot #1, 2,3, 4 and back to #1. It's by design, they want you to go away. None of these idiots can actually help you, they're in your way.

They also know attorneys won't go away that easily. They'll throw up roadblocks until a qualified elder care attorney calls.

Good luck.

What you say rings true. Especially the bumbling idiots line.

And in speaking with other regular folks who have to deal with eldercare, it seems that jumping through all the hoops the right way gets them nowhere. Then they hire an attorney (and the fee is always $7,000 for some reason) who jumps through the same hoops but gets the desired result.

I am afraid I can't count on the care facility for help. They seem to me to be out for maximum profit. Maybe there's more profit in memory care.

They have already ripped my parents off for $1,500 for the use of a treadmill for a few hours over a few days, for 'gait training'. Dad was using the treadmill in the gym, and someone there suggested he get 'gait training', so he did. No one mentioned the $1,500. My mom tried to file a claim to her insurance and it was rejected. She politely paid the $1,500 ripoff, just to not make anyone angry. I bet she feels somewhat helpless.
It's disgusting.

 

[target2019]

In-laws have had a good experience with two JH LTC policies. Once the determination is made, it is a process to follow up with billing invoices. But they have paid out a large amount of funds for necessary care. If a facility bills you for unnecessary services, it is not the responsibility of the insurer.

 

[Potstickers]

We found an eldercare attorney by looking at who was speaking on eldercare issues at bar association sessions in the county where my mom lived.

Do you have a copy of the LTC policy and have you carefully read the definitions and coverage documents? MIL had LTC (but not through Hancock) and we found her LTC insurer to be very, very persnickety -- but once we met their conditions, they paid very promptly. Nothing got paid until their RN came in and evaluated MIL in addition to the various certifications provided by her doctors.

 

[FreeBear]

Another sobering thread on LTC insurance. My heart goes out to you John and your family.

Honestly, it's another thread that keeps me inclined to keep my $$ invested, and hope it outlasts me. Another scary thought is that DW and I are the "end of the line". We don't have younger family to advocate for us. At least I'm a praying man...

 

[Z3Dreamer]

I guess I am weird. Having been in Finance, I had to pick and administer insurance policies, so I read the fine print. When I heard of fires, break-ins and injuries in the news, I would look them up in our policy to see if we would be covered. In my personal life, I have had LTC through a professional association since my early 30's. I have read the policy and I glance every time they make a change to include additional services. All policies have a waiting period, a qualifying event and covered services. As long as you follow all 3, a big company like JH will cover it. I believe they would deny a claim if you did not comply with any of the 3.

Having defended insurance companies, now I can turn to the other side. When they began offering LTC, insurance companies missed on the actuarial computations. Many have stopped offering them as they have incurred horrible losses. I believe they would take whatever steps to deny a claim.

My 2 cents.

 

[REWahoo]

Threads like this prompted my discussion of potential LTC insurance claims issues with an eldercare attorney, who recommended the services of a Claims Assistance Professional (CAP) Alliance of Claims Assistance Professionals.

She said she had referred a number of her clients to a local CAP ( Your Medical Claims Expert ) with good results. Probably less costly than an attorney and very knowledgeable about jumping through the necessary hoops to get claims paid.

 

[JoeWras]

We have and are not dropping it yet. No claims, of course. Nord's experience was sobering.

I've decided if we need it, it is time to get an attorney. Sad.

Nords may chime in. He occasionally looks out for threads to respond to. I think his dad recently passed, so many condolences to him.

 

[PoorOldCountryBoy]

Claims

The purpose of the claims department in an insurance company is to minimize the amount of money paid--nothing personal, just business.

I've done claims systems for insurance companies and know the procedures there to minimize costs. That said, a well established insurer wants to stay on the right side of the law and avoid bad PR like JH seems to be getting here.

You need an advocate. The state insurance commissioner's office may be a good first contact, but honestly I'd go with the best local elder care attorney.

Quite often a good Elder Law attorney can set you straight in a single meeting, or send you to someone cheaper than them for follow-up. And their doctors can help give opinions necessary for a care option to be possible.

Good luck!

 

[target2019]

All policies have a waiting period, a qualifying event and covered services. As long as you follow all 3, a big company like JH will cover it. I believe they would deny a claim if you did not comply with any of the 3.

I am glad you filled in that information. It helps to understand that the policy is not something you can turn on like a spigot. My in-laws' family had misconceptions about the JH policy, and how it would be used. Here are some data points, just my take YMMV.
- When both were in independent living (5k/mo), there was a diagnosis by JH RN when requested. It was border line, but a few months later the situation progressed. Return by RN, and it was ok'd, as more conditions were obviously met.
- Then a waiting period. We brought in a local caregiver service to provide help during the day. This was out of pocket, as the waiting period had not expired.
- Sometime between the qualifying event and expiration of waiting period, it was obvious to everyone that mom needed the memory unit (8k/mo). Without the JH LTC, the draw-down of their money would have been tremendous. The effect on family would have been emotionally devastating.
- Effectively, JH LTC paid for 4 years of the memory unit for M-I-L (now 10k/mo). The policy has just paid out final $$'s.
- About 3 years ago, F-I-L (just passed) moved to assisted living, his policy had kicked in for caregiver services before that. JH LTC reimbursed his AL bill (last was about 8k/mo).

I have to admit, I though M-I-L was not wise for paying for LTC. Each year I tallied up their income and expenses, and did taxes. Say it was 5K for both policies annually. Too much, I believed. In their case it has permitted moving them from their home to independent living, and then to assisted living and memory unit. The facility is nice, and I have to say a good choice. The children all make regular visits, and comment on what they see as negative experience. Some do not express their thoughts very well, and may think that insurance companies and facilities should take marching orders, and just do it. However, it does not work that way.

Over these 4-5 years, directors and employees have changed. It helps to have personal contact with as many people as possible. Some of these employees regularly contacted us, to give us more information, advice, etc.

Sorry for the length, but I wanted to share a positive story. It must be true that others have had negative experience with LTC and facilities. However, there are happy stories, too.

 

[JoeWras]

Thank you target!

 

[sheehs1]

JohnGalt III...Your experience and others I have read is why I cringe a bit regarding LTC and have not done anything..yet. I decided to save and save to self insure. My only daughter would be lost in trying to submit claims on my behalf (I think). I could always appoint someone but that too comes at a cost.

Best of luck with getting things straight for your Dad. One should not have to hire a lawyer to enforce the LTC policy but unfortunately that seems to be the case more often than not.

 

[Sunset]

The purpose of the claims department in an insurance company is to minimize the amount of money paid--nothing personal, just business.

I've done claims systems for insurance companies and know the procedures there to minimize costs. That said, a well established insurer wants to stay on the right side of the law and avoid bad PR like JH seems to be getting here.

.....

+1

I once worked with an ex-insurance claims worker, she said she finally quit in disgust to a new career as her job back then had been to deny claims, if you can't deny a claim then delay, delay, delay, until the client goes away.

It really struck home to me, as her relating a tale of life insurance delay for many years and still not paid out, was like my friends father's life insurance. The insurance company said on a 20-25 yr old policy they would not pay out the $100K, but if the widow took only $50K, they would pay out of compassion

 

[John Galt III]

Thanks for the replies. I'm glad to see a few good experiences mentioned with John Hancock!

Yes, my sister and I have both pored over the policy. The terminology and definitions are vague and overlapping and seem to be flexible so that Hancock can decide what they mean at claim time. For example, the policy stated that an aide coming to the home would be paid for. Nothing was mentioned in the policy to define 'home' as far as I can recall. No mention of independent living at a ccrc being disqualified. You find that out after the claim is filed. A ccrc staff member and my mother made a call to John Hancock prior to submitting the claim, to verify that the claim would be approved. It was actually the ccrc staff that wanted Mom to get an aide to watch Dad, only 2 days per week for a couple hours each day. The customer service rep at Hancock said yes it would be covered. But it was not. Since then, my sister and I have been trying to get it in writing, as opposed to a phone call, that a memory care unit would be covered. When we mail them a letter asking them to confirm coverage for memory care, we get a letter back that ignores the question about memory care, and responds to the old denied claim for home aides. They are truly brain dead, it seems. Or sure are acting that way. This apparently is one of the delay tactics.

My sister is doing the letter writing and phoning, and documenting everything, and I am helping her however I can. I am only 1.5 hours away so I can drop in to see Mom and Dad, and read the letters they have saved, and the JH contract. My sister has to fly in whenever she visits. She is much better at this paperwork stuff. Her mind is still good, my memory is poor, unfortunately, and I have to constantly reread stuff to keep it in my memory. Very inefficient! I do the best I can.


What's frustrating is that all Mom has to do is keep better tabs on Dad and not assume he will go to the gym if she tells him to go there. Of course he wanders off somewhere, security finds him, and the staff chalks up another black mark against him. That's why they want him to either get 24 hour aide (not covered apparently) or go into memory care (which looks like it is covered under the policy, but no mention of the actual words 'memory care' in the policy, just vague terms like assisted living, skilled nursing facility, alternate care facility, dementia, activities of daily living). I am assuming a memory care unit will be considered an alternate care facility, which the policy says is covered, but that's up to John Hancock.

My mom is supposed to be meeting with the staff soon to talk about moving Dad into memory care, and I have volunteered to be there, on a conference call with John Hancock. I dread it. My sister, who has been flying up for these things in the past, is making excuses for why she can't make it this time. I attended one of these 'family meetings' at the ccrc before, with 2 lower level staff, Mom, Dad, me, and my sister, about the possibility of moving into assisted living, not memory care, and I couldn't make sense out of the torrent of unnecessary words. They never seemed to get to the point.

I'm not quite ready to hire a person to attend the meeting with me. That seems so excessive.

My sister agrees we may need an attorney, but only if John Hancock drags out or denies the memory care claim.

 

[REWahoo]

I'm not quite ready to hire a person to attend the meeting with me. That seems so excessive.

Not when you step back and read what you wrote in the paragraph leading up to this ^ statement:

I attended one of these 'family meetings' at the ccrc before, with 2 lower level staff, Mom, Dad, me, and my sister, about the possibility of moving into assisted living, not memory care, and I couldn't make sense out of the torrent of unnecessary words. They never seemed to get to the point.

Sounds like a tailor-made situation for assistance from someone well-versed in the process and jargon.

 

[MRG]

Not when you step back and read what you wrote in the paragraph leading up to this ^ statement:


Sounds like a tailor-made situation for assistance from someone well-versed in the process and jargon.

+1

The sooner you hire an expert(BSD) you will be having different conversations with different people both at the home and with JH. Until that time the insanity continues; they make it a practice to deny as long as possible hoping you give up or your family member passes.

 

[MissMolly]

We actually had no problems with John Hancock covering my mom. But, she had been DX'd with frontal lobe dementia and another LTC rep told me she would be a shoo-in for coverage due to that. First they covered in-home care with aids, and when she got beyond being able to stay at home, they covered her assisted living costs.

 

[Sarah S]

My sister had no issues with JH. They approved her right away ( though she had a waiting period for home care ) and paid for a few home renovations ( to the limit allowed). I suspect certain diagnoses are easier to get approval as with the FTD above. My sister had ALS.

 

[mickeyd]

John Hancock is in business to make money. Paying out money defeats the purpose. Delay, deny, repeat.

All the more reason to self-insure all LTC risks.

 

[Banned LTC Salesman]

When my relative decided to file a claim on her long-term care policy we contacted one of the national home care agencies and they handled it for us. This particular home care company processes thousands of long-term care insurance claims every year. All we had to do was sign a couple of HIPAA forms and they took care of the rest. Her claim was approved in three weeks and it was with John Hancock.

If you think about it this makes perfect sense. The home care agencies get paid by the long-term care insurance companies. The bigger home care agencies have a financial incentive to set up a system to successfully process long-term care insurance claims. They know each company's nuances.

The hard part about filing a long-term care insurance claim is that it’s something you only do ONCE in your lifetime. Most doctors don’t know what’s required to file a claim. Each state has laws that require the insurance companies to make a claims decision, usually within 60 days of receiving the claim form. If the insurance company has not received the medical records and the claim certification from your doctor within that time period the insurance company has to deny the claim. You then have to re-open it, which is a real pain.

We were very pleased with the process.

 

[REWahoo]

When my relative decided to file a claim on her long-term care policy we contacted one of the national home care agencies and they handled it for us. This particular home care company processes thousands of long-term care insurance claims every year.

Can you let us know which agency you used? Was your only relationship with this company your claims filing requirement?