Turned Down for Long Term Care Ins

[someday soon]

Hey All,

After lurking here a lot here and writing very little, a postable experience struck me yesterday.

I'm 60, and very, very fortunate because I feel great, and have gone my whole life without an extended illness, without a day in the hospital, and without a lengthy prescription. So I was a bit shocked when I read the letter saying that I was turned down for Long Term Care insurance by company X.

I'm a bit concerned that my doc's historical records - which I've never had the need to look at - may have been misinterpreted or overblown. Perhaps an ache that came & went some time ago was somehow taken as "he has persistent chest pains" ...that kind of thing. Of course I'm speculating a bit here and wanting to see my own health history in the best possible light, whereas ins underwriters may see things quite differently.

Questions for those who have been declined for LTC or know about LTC underwriting procedures:

* Does being declined by one insurer for LTC mean all others will decline you as well?
* Does discussing things with insurer X after being declined have any merit?
* Glad to hear any relevant experiences you've had after getting turned down ...did you apply for other forms of LTC? did you take a whole different path regarding LTC?

PS: No need to veer into related juicy topics here ( the value or stupidity of choosing LTC ins, the value or stupidity of insurance companies in general, etc, etc ) ...there's other threads for that.
Just interested in thoughts related to getting declined for LTC if you don't mind...Thanks!

 

[Sunset]

Did the letter specify the reason ?

If it was your doctor records or other medical records, then you may want to review those records first before applying to other companies.

There is the remote possibility, some sick person used your SSN for treatment, and so it goes on your record.

Did you do DNA testing at any time ?

 

[Corporateburnout]

When we both applied for LTC seven years ago at the age of 59, DW application was declined due to her new PCP's statement that she decided to stop a medication prescribed by a former PCP on her own. That was not the case. It was a mutual decision with the PCP to stop the medicine due to some side effects.

We appealed the decision but the process was so lengthy and cumbersome that after a year we decided to drop her application.

 

[braumeister]

No experience with the topic, but I can verify that my records at my previous PCP were royally messed up. Full of inaccuracies, and I could never get them corrected. When I left that practice I specifically told my new doc that I wanted to start out fresh with a new record, and I told him why.


They are your records, so no reason you can't look them over. They can charge you to print a copy, but they can't withhold them from you.

 

[Big_Hitter]

we were both declined a few years go - I don't think any inscos want to write this any longer - they've lost their asses on ltc

 

[harllee]

DH was turned down for the AARP/UHC medicare supplement when he was trying to switch to it from Mutual Of Omaha to try to get a lower premium. DH was told that he was turned down because his doctor's notes said he "might" be a candidate for knee replacement some day. UHC told him to reapply after he get the knee replacement but right now his knee is fine and he does not need a knee replacement.

 

[ziggy29]

I think a lot of insurers are gun-shy about this product now, because it seems like they have difficulty pricing it appropriately given how fast costs are rising.

 

[ERD50]

I think a lot of insurers are gun-shy about this product now, because it seems like they have difficulty pricing it appropriately given how fast costs are rising.

That's what I wonder about too. Hearing this 2nd hand, but my SIL (~ 58 YO) got declined for LTCI, supposedly due to knee replacement. I suppose that could be a sign of future issues, but it also sounds like an extreme way to filter out just about any but the healthiest?

But I also wonder about how much of a predictor something like that is? But I suppose a knee replacement at that age is not a good sign. But she's also overweight, and I think that played into the knee replacement (simple mechanics - more weight means more stress/strain on the knee). So maybe that was a 'nice way' to decline?

-ERD50

 

[ncbill]

Did you use an independent broker or just apply to the company directly?

IIRC the hybrid policies (insurance w/ LTC rider) are easier to qualify for but cost much more.

 

[EveryLady]

I reviewed my medical records prior to starting any application for LTC. They were full of inaccuracies. I've developed a somewhat personal patient relationship with one doctor whom I saw only to maintain my current-patient status. We often just chatted, about my daughter or traveling. The tip-off should have been that she keyboarded constantly! My offhand comment that I was getting older - our hiking in the Dolomites sometimes left me weak-kneed at the top of a trail and a little dizzy got coded as my experiencing vertigo.

There were other examples, with one where I was coded as being diabetic. I once had a hbA1C of 5.8 (impaired glucose tolerance at best) that soon fell back to its decades long normal within the 5.0 to 5.4 range and that with carb-heavy 'normal' eating patterns. I test post-prandial occasionally for my mother was diabetic.

Unfortunately the former doctor moved her practice out of state and the latter doctor retired. Trying to correct the records might have been difficult. Already uncertain about the product (this was my last of several reviews over the years), I didn't apply.

 

[Z3Dreamer]

Similar experience with life insurance. The company had a big policy on me. Cost was high because I weighed so much which caused pre-hypertension, pre-diabetes and maybe a few other "pre's". Lost a bunch of weight and got re-tested. No "pre" anything. Asked the company to re-rate the policy. They agreed that currently I was fine, but they did not change the rating because I could possibly regain the weight and get the conditions again.

You could use this absurd logic with anything. The underlying point is that they must have enough business that they can be selective.

 

[Bongleur]

When I left that practice I specifically told my new doc that I wanted to start out fresh with a new record, and I told him why.

I don't think that is possible anymore. As I understand it, the Obama stuff created a requirement to put records into a central repository. You might have to go thru some some of legal process to try to expunge your records from this -- and your insurance company would probably drop you if that happened, and no other would cover you.

 

[Telly]

All bow before the great MIB.

Long before President Obama, the insurance companies, through insurance industry associations, got together and created "the MIB", the Medical Information Bureau. This is used by probably every insurance company doing anything with health. Supposedly, it was originally created to fight fraud, but as a big health database, it became used for everything. Whenever you apply for health, LTC, etc. etc. insurance, you sign off that you agree for the insurance co. to look at your health data. I strongly doubt that ANY company out there would NOT check the MIB!

I had a thread here back about 2003, 2004 about the MIB. I provided a link that you could mail away to them, along with $10 I think it was back then, to view what the MIB had on you. At the time, I did not exist in the MIB! Why? Because I had not done anything for years that would have put me into the database, so as the MIB started and rolled along, there never was any data for my name, nor even my name! Well, that was then... I'm sure I exist now!

"Not existing" meant that I had not seen a doctor or any medical professional in many years, and they started the MIB in that time frame. I doubt that anyone drops out of the MIB, once they're in it.

The MIB knows all. Whether it is correct or not. I think everyone feeds it info.

 

[Bongleur]

Long before President Obama, the insurance companies, through insurance industry associations, got together and created "the MIB", the Medical Information Bureau.

I believe doctors are under a lot more pressure now to feed info, they MUST computerize instead of keeping your records private, on paper, in their office. Certainly any MD affiliated with an employee health insurance scheme.

I understand they even get dinged for writing too many paper scrips (see the threads on the difficulties of prescription price shopping).

 

[ziggy29]

Here's a link for requesting access to your MIB file, if any. Consumers have the right to request it once a year (like the free credit report), and when declined for an insurance application when MIB was used as part of the decision:

https://www.mib.com/request_your_record.html

Note that it says you won't have a file unless you have applied for *individual* health or life insurance within the last few years.

 

[someday soon]

Hey all ...OP here -- really appreciate the time you took for responding with stories and feedback.

In answer to some of the questions:
* I did the DNA testing thing a few years ago ...hope that has not caused some bizarre mixup in my LTC results.
* My rejection letter speficially stated 4 or 5 things from my doc's records that caused the decision
* I applied for LTC via a broker, not directly to the insurer.
* I applied for just insurance ...not a 'hybrid' policy

Yes, your replies had some valid points about underwriting that's perhaps tighter than it used to be. Good to be reminded of that.
As for the MIB, sounds ominous if you ask me. Might have to use that link and see what's lurking in there...

Updates since the opening post:
* The broker is encouraging me to resubmit to the same insurer after getting a letter from my doc refuting the ( perhaps overblown ) items that fueled the decline decision. I don't know if every LTC provider allows this kind of recourse, but apparently this one does.
* My doc is open to writing such a letter, though he may want to do a full physical to verify his revised notes.
* My broker also claimed that 1 in 5 of his LTC applicants get initially declined, and half of those declines get reversed or covered by a different company

 

[zippy2020]

...As for the MIB, sounds ominous if you ask me. Might have to use that link and see what's lurking in there...

* My broker also claimed that 1 in 5 of his LTC applicants get initially declined, and half of those declines get reversed or covered by a different company

I used to work for CIGNA and coded application info to the MIB every day. That was decades ago and they might have changed things, but basically the info we sent was what you could call a 'medical shorthand'. So if you had a cardiac infarction (heart attack) and were on medication afterwards, that was a numeric code; along with date listed as occurrence date.

Each insurer had its own ID code, so it was clear where the info came from.

You might not be surprised to learn that MANY people lie on insurance applications - "Oh, I'm in good health, never been rated by any company!"

Really? Then why does the MIB say you applied and were turned down for a life insurance policy five years ago?

++++

If your doctor is willing to correct erroneous medical info on your record, you should do so ASAP. You would not let mistakes slide on your financial records; your health records are equally important.

Every insurer has their own underwriting standards. Your broker is absolutely correct that you should apply to other companies. It won't take long; there are only a dozen or less companies remaining in the LTCi marketplace.

Be prepared for extremely high premiums. The "traditional wisdom" of applying for LTCi when turning 60 has not been valid for many years now. The market is now so small, and so few US consumers are willing/can afford it, that adverse selection has caused higher premium rates.

I have been telling people for two decades that the sweet spot for applying is before age 50. Even with the premium increases we have received, our total outlay for two separate LTCi policies over 20 yrs, with the type of generous benefits that can't be purchased any longer, is less than the cost of 6 mos. stay for one of us.

My spouse had a haemorrhagic stroke 4 yrs after we bought the LTCi policies. We would have spent much, much more trying to get him covered after that, compared to the cost of his current policy.

 

[someday soon]

Quick update from the OP:

After posting and seeing your answers last spring, I chased down my doc and a pulmonology practice ( in the middles of the spring/summer COVID chaos no less ) and asked them to perform whatever tests/checks would specifically address the conditions in the LTC denial letter.

Took quite a few months, but it's all done now -- I re-submitted to the LTC ins company and got accepted. Just paid my first annual premium ...is it a good investment? haha that's the subject of many other threads around here!

Thanks to all who stopped by and chimed in!

 

[Koolau]

Quick update from the OP:

After posting and seeing your answers last spring, I chased down my doc and a pulmonology practice ( in the middles of the spring/summer COVID chaos no less ) and asked them to perform whatever tests/checks would specifically address the conditions in the LTC denial letter.

Took quite a few months, but it's all done now -- I re-submitted to the LTC ins company and got accepted. Just paid my first annual premium ...is it a good investment? haha that's the subject of many other threads around here!

Thanks to all who stopped by and chimed in!

We will all hope that you are "wasting" your money since YMMV.

 

[WyomingLife]

This thread is very interesting for me, as DW and I purchased LTC policies for both of us when I was about 50 (she is a bit older than I). The premiums have gone up over time, so the following is an approximation, but I estimate we have paid about $700/month for those two policies over the years. So to date, we have paid a total of approximately $60,000 in premiums ($700 x 12 x 7). It may be 25 more years (if ever) before we start to claim under those policies.

Our LTC premiums now are far and away our largest monthly expenditure.

I freely admit that I still have no idea if LTC (even if still obtainable in the market) is necessary or wise. I used to believe that we obtained coverage way too soon, but then I read these threads and get confused. Most months I feel like all we are doing is throwing money at the insurer.

 

[RetMD21]

I estimate we have paid about $700/month for those two policies over the years. So to date, we have paid a total of approximately $60,000 in premiums ($700 x 12 x 7). It may be 25 more years (if ever) before we start to claim under those policies.

It's hard to know. If it is money that you wouldn't miss there is no harm. I have "over saved" to cover various contingencies including ltc so maybe it isn't that muchdifferent.

 

[Koolau]

This thread is very interesting for me, as DW and I purchased LTC policies for both of us when I was about 50 (she is a bit older than I). The premiums have gone up over time, so the following is an approximation, but I estimate we have paid about $700/month for those two policies over the years. So to date, we have paid a total of approximately $60,000 in premiums ($700 x 12 x 7). It may be 25 more years (if ever) before we start to claim under those policies.

Our LTC premiums now are far and away our largest monthly expenditure.

I freely admit that I still have no idea if LTC (even if still obtainable in the market) is necessary or wise. I used to believe that we obtained coverage way too soon, but then I read these threads and get confused. Most months I feel like all we are doing is throwing money at the insurer.

Wow, those must be some good policies with lots of coverages. Ours, taken out about the same ages (and yes, premiums did go up) are less than half your premiums. Don't recall the details, but remember they have a 5% increase/year on the payout/day for (IIRC) 3 years (or was it 4?). YMMV

 

[Dd852]

I’m just in the process of trying to claim LTC for my mother, and I have to say the experience has made me very loath to get coverage myself. Of course I understand that insurance companies need to make a profit and so don’t like to pay out but I really wonder whether the premiums wouldn’t have been better simply invested! I’d never advise that for ordinary medical or home insurance, but the definitions of what “care” means and the policy insistence on getting her to some mythical base level rather than an actual ability to take care of herself makes me wonder if the wording on these policies is particularly loose in the favor of the company. She is with MetLife which no longer even writes LTC so perhaps it is a function of their running down the unit but I’ve found it stressful and irritating! At least with medical insurance we can all agree what a doctors visit is or what an xray is; in home insurance a theft is pretty clearly a theft and a fire is pretty obvious as well. But LTC seems... squishy. And not in a good way. Probably they will pay in the end, but the cost to my mental health is ... uncovered!

 

[Koolau]

I’m just in the process of trying to claim LTC for my mother, and I have to say the experience has made me very loath to get coverage myself. Of course I understand that insurance companies need to make a profit and so don’t like to pay out but I really wonder whether the premiums wouldn’t have been better simply invested! I’d never advise that for ordinary medical or home insurance, but the definitions of what “care” means and the policy insistence on getting her to some mythical base level rather than an actual ability to take care of herself makes me wonder if the wording on these policies is particularly loose in the favor of the company. She is with MetLife which no longer even writes LTC so perhaps it is a function of their running down the unit but I’ve found it stressful and irritating! At least with medical insurance we can all agree what a doctors visit is or what an xray is; in home insurance a theft is pretty clearly a theft and a fire is pretty obvious as well. But LTC seems... squishy. And not in a good way. Probably they will pay in the end, but the cost to my mental health is ... uncovered!

Thats very unfortunate. It's been 20+ years but I had very little problem qualifying my mom for her LTC when she entered the nursing home. I had ONE person to deal with. I had the nursing home send paperwork to the company. The benefits kicked in in plenty of time for mom to be covered. Sorry you are having problems.

 

[harllee]

I’m just in the process of trying to claim LTC for my mother, and I have to say the experience has made me very loath to get coverage myself. Of course I understand that insurance companies need to make a profit and so don’t like to pay out but I really wonder whether the premiums wouldn’t have been better simply invested! I’d never advise that for ordinary medical or home insurance, but the definitions of what “care” means and the policy insistence on getting her to some mythical base level rather than an actual ability to take care of herself makes me wonder if the wording on these policies is particularly loose in the favor of the company. She is with MetLife which no longer even writes LTC so perhaps it is a function of their running down the unit but I’ve found it stressful and irritating! At least with medical insurance we can all agree what a doctors visit is or what an xray is; in home insurance a theft is pretty clearly a theft and a fire is pretty obvious as well. But LTC seems... squishy. And not in a good way. Probably they will pay in the end, but the cost to my mental health is ... uncovered!

Disturbing to hear of your troubles in getting your mom's LTC insurance to pay--it makes me especially concerned since my mom also has coverage with Metlife also. I did the calculations and my mom has paid more in premiums over the years than she could ever receive in payment to so she would have definitely been better off saving her money.