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

[Z3Dreamer]

Seems like I have spent a lifetime dealing with insurance companies. Yes, they move slow. Yes, they deny every time the wind blows unless every "I" is crossed and every "T" is dotted. And I have had them agree to pay but take 6 months to do so (on a commercial fire claim). I have some observations and suggestions. I do not know how many times you have tried faxing various documents and the like, so based on what I read, I think it may be premature to go nuclear. A company the size of MetLife is not going to purposefully lose docs and the like. Incompetence is a real thing. I would suggest that Person A got the document but has not yet put it in the system, then they left for the day or week. So Person B can't find it.

It is also possible that an inherited policy from another company is in another system or has different policy numbers than they can look up. I have had this with companies inheriting another company's book.

I found the MetLife LTC claims website for this and it looks straightforward. It also says you can email the Initial Claims Packet Submission to LtcIntake@metlife.com. I mention this because you mentioned that they don't allow electronic submission. Maybe you are speaking of the doctor's form and sending a copy of the policy.

Looks like once you have done the initial submission you are assigned an adjuster. They call it a Care Coordinator. I mention this because it says you will have this person's direct contract info. Looks like they will provide updates every 30 days.

Maybe you have done all of this and it is not working. Maybe I am giving you basic stuff and you are way beyond it. At least I spent some time trying to help.

 

[Koolau]

Seems like I have spent a lifetime dealing with insurance companies. Yes, they move slow. Yes, they deny every time the wind blows unless every "I" is crossed and every "T" is dotted. And I have had them agree to pay but take 6 months to do so (on a commercial fire claim). I have some observations and suggestions. I do not know how many times you have tried faxing various documents and the like, so based on what I read, I think it may be premature to go nuclear. A company the size of MetLife is not going to purposefully lose docs and the like. Incompetence is a real thing. I would suggest that Person A got the document but has not yet put it in the system, then they left for the day or week. So Person B can't find it.

It is also possible that an inherited policy from another company is in another system or has different policy numbers than they can look up. I have had this with companies inheriting another company's book.

I found the MetLife LTC claims website for this and it looks straightforward. It also says you can email the Initial Claims Packet Submission to LtcIntake@metlife.com. I mention this because you mentioned that they don't allow electronic submission. Maybe you are speaking of the doctor's form and sending a copy of the policy.

Looks like once you have done the initial submission you are assigned an adjuster. They call it a Care Coordinator. I mention this because it says you will have this person's direct contract info. Looks like they will provide updates every 30 days.

Maybe you have done all of this and it is not working. Maybe I am giving you basic stuff and you are way beyond it. At least I spent some time trying to help.

Sounds good. You have proof you sent it and the recipient can't deny it. Used to be USPS was only acceptable if you sent certified. I think FAX is a close second method.

 

[harllee]

This is a good idea. Complaining to the state insurance regulator may also help. Insurance is state regulated and the regulators have a great deal of influence.

Nords wrote a thread detailing all the issues he dealt with trying to get LTCI to pay for his fathers care. It was written more than 10 years ago but this situation looks quite similar. https://www.early-retirement.org/fo...-and-asset-allocations-55688.html#post1064097

I have skimmed through Nord's thread. What a time he had managing his fathers assets and his LTC insurance. Fortunately, I already have my mothers POA and have presented it to all the financial institutions and have taken over all her assets. But I am just now starting down the LTC insurance nightmare. One of my main problems is I am age 71 and have an older husband and having to deal with this on top of my own issues (like moving into a CCRc next month) is just overwhelming. I don't know if I will be able to handle all this.

 

[RetiredHappy]

After we left our high tech careers, we started a home care company. We dealt with LTC insurers all day long and got assignment of benefits so that the companies paid us directly. We never had a problem with MetLife, Genworth or CalPERS. Now, that was 7 years ago when we sold our company so maybe things have changed since then. We helped families navigate the paperwork and process in order to get approved, for instance a care plan which showed the clients needing assistance with at least two ADLs (Activities of Daily Living).

I would suggest that you try escalating up the chain at MetLife first. Maybe COVID resulted in everyone working from home so no one was picking up faxes.

 

[harllee]

After we left our high tech careers, we started a home care company. We dealt with LTC insurers all day long and got assignment of benefits so that the companies paid us directly. We never had a problem with MetLife, Genworth or CalPERS. Now, that was 7 years ago when we sold our company so maybe things have changed since then. We helped families navigate the paperwork and process in order to get approved, for instance a care plan which showed the clients needing assistance with at least two ADLs (Activities of Daily Living).

I would suggest that you try escalating up the chain at MetLife first. Maybe COVID resulted in everyone working from home so no one was picking up faxes.

Could I hire you?

 

[Texas Proud]

Another reason not to buy LTC insurance...

 

[Koolau]

Another reason not to buy LTC insurance...

A better reason not to buy it is that you don't end up needing it.

Hopefully, you can eventually deal with recalcitrant LTC insurance companies. But if you DON'T have LTCi and NEED it, it's too late and you would welcome dealing with the "evil" insurance companies.

 

[RetiredHappy]

Could I hire you?

But seriously, you should lean on the CCRC to help navigate it. They are likely to have a direct contact to MetLife. The CCRC should be more than willing to help since they would like to be paid.

 

[harllee]

But seriously, you should lean on the CCRC to help navigate it. They are likely to have a direct contact to MetLife. The CCRC should be more than willing to help since they would like to be paid.

The CCRC is helping me. They have made several calls. They say this is typical of LTC insurance companies to delay payment, especially companies that have quit selling new policies (which is most of them). The "we can't find your policy" or "we can't find your fax" is a normal delaying tactic.

 

[aja8888]

The CCRC is helping me. They have made several calls. They say this is typical of LTC insurance companies to delay payment, especially companies that have quit selling new policies (which is most of them). The "we can't find your policy" or "we can't find your fax" is a normal delaying tactic.

Sounds like the same IRS folks that lost my business income tax return in 2017 and also never saw the faxes I sent after that. That mess took 4 years to straighten out (in my favor).

Good luck!

 

[nwsteve]

Given the ease of deniability ioffaxes, I wonder if the old fashion choice of envelope, sent via Fed/EXp/USPS/UPS overnight with signature required might cut the convo short when there is signature, date, etc is from third party in hand. Yes, more expensive than your fax but a whole lot less stress than repeating and repeating. ��*

 

[Koolau]

Given the ease of deniability ioffaxes, I wonder if the old fashion choice of envelope, sent via Fed/EXp/USPS/UPS overnight with signature required might cut the convo short when there is signature, date, etc is from third party in hand. Yes, more expensive than your fax but a whole lot less stress than repeating and repeating. ��*

I agree, but think a fax is a pretty reliable proof of receipt. Not sure where you will have to "prove" something with the proof. Maybe to the State Insurance Regulatory Commission.

My gut says a "threat" to call the State might just w*rk. Especially if all ducks are lined up on your side. Continuing hope of good luck to OP. Bummer that you have to take this on. I hope you are blessed for doing it.

 

[pacergal]

I am so sorry you are going through this, I imagine the stress of the change in your Moms health, the problem of the insurance claim, and your upcoming move is quite challenging.

Besides contacting Your State insurance department, I would also try sending letters and/or calling your local representatives and State lawmakers. Sometimes an inquiry from a State Senators office gets things going.....

 

[harllee]

Given the ease of deniability ioffaxes, I wonder if the old fashion choice of envelope, sent via Fed/EXp/USPS/UPS overnight with signature required might cut the convo short when there is signature, date, etc is from third party in hand. Yes, more expensive than your fax but a whole lot less stress than repeating and repeating. ��*

Yes I will start mailing things signature required even though the insurance company asks for a fax.

 

[harllee]

The other irritating thing about all this is 30 years ago when my DM asked my advice about LTC insurance I told her she did not need it and to take the premium amount and invest it. If she would have done that she would have come out MUCH better. AND I would not have to be messing with all this! We are blessed that DM has sufficienct assets to pay her own way for many years--if the LTCI never pays she will still get great care in the CCRC. Plus her CCRC has a trust fund that pays the fees for anyone who runs out of money.

 

[Texas Proud]

A better reason not to buy it is that you don't end up needing it.

Hopefully, you can eventually deal with recalcitrant LTC insurance companies. But if you DON'T have LTCi and NEED it, it's too late and you would welcome dealing with the "evil" insurance companies.

The other irritating thing about all this is 30 years ago when my DM asked my advice about LTC insurance I told her she did not need it and to take the premium amount and invest it. If she would have done that she would have come out MUCH better. AND I would not have to be messing with all this! We are blessed that DM has sufficienct assets to pay her own way for many years--if the LTCI never pays she will still get great care in the CCRC. Plus her CCRC has a trust fund that pays the fees for anyone who runs out of money.

Harliee has my thought down...



I will never 'need' it... the chance that I will live in a home for any long term is not great.. I can see numbers that say up to 3 years but there is the below study that says the medium is 5 months...


My mom was in for about a year and she was in a small 16 person home... during that year 6 people passed that I know of... it could have been more..


Now, we did hire help for my mom for a few years before she needed to go in but that would not be covered by insurance and she did not 'need' to go in before we move her there... a broken pelvis (not her hip) was the start of her demise...



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945440/



Decedents’ lengths of stay in nursing homes at the end of life are illustrated in the Figure. The mean length of stay among decedents was 13.7 months; however, this was explained by a relatively small number of subjects with long lengths of stay. The median length of stay was only 5 months (IQR 1-20). The majority of residents had short lengths of stay, 65% percent of decedents had lengths of stay of less than one year, and over 53% died within 6 months of admission.

 

[Math]

I would talk to your DM CCRC and find out who the Elder Care Advocate is in your state. This person is a wealth of information and can point you in the right direction. My mother’s LTC was with Bankers Life and it always took several tries to get the right forms turned in. I was very fortunate that my mother’s facility was very helpful but it was very frustrating. It was a great day when I had exhausted her benefits and knew that I would no longer get correspondence from them.

 

[RetiredHappy]

I would talk to your DM CCRC and find out who the Elder Care Advocate is in your state. This person is a wealth of information and can point you in the right direction. My mother’s LTC was with Bankers Life and it always took several tries to get the right forms turned in. I was very fortunate that my mother’s facility was very helpful but it was very frustrating. It was a great day when I had exhausted her benefits and knew that I would no longer get correspondence from them.

Bankers Life was problematic back then but they were levied a huge fine for delaying and denying claims, before they became compliant with approving claims.

 

[Koolau]

Bankers Life was problematic back then but they were levied a huge fine for delaying and denying claims, before they became compliant with approving claims.

Heh, heh, I wonder if that is why our premiums went up! Maybe we were paying the fine and helping BL become responsible by actually paying out claims!

Maybe we won't have to go through the "game" they used to play if we need to use the coverage. I hope the fine was enough to make them responsible to clients.

(Better yet - may God grant me the desire of my heart that I never need the coverage, that it was a total waste of money, and that I simply wake up in heaven.)

 

[Valid not Invalid]

Very sorry you are going through this. My Dad had paid premiums for years through the federal gov’t’s LTCI. When it came time to use it, I was explaining his limitations on fixing meals and his inability to walk from the bedroom to the kitchen. I recall the representative telling me that if he could take a spoon from the bowl to his mouth, then he didn’t qualify for the insurance. And it was still going to be 90 days before the insurance took effect. I found out that if the doctor declared him eligible for hospice, the benefits were to start immediately. He never got any benefits as he died later that night. The lesson here is, once they acknowledge you have a policy, a hospice declaration may help you get benefits immediately.

 

[harllee]

Very sorry you are going through this. My Dad had paid premiums for years through the federal gov’t’s LTCI. When it came time to use it, I was explaining his limitations on fixing meals and his inability to walk from the bedroom to the kitchen. I recall the representative telling me that if he could take a spoon from the bowl to his mouth, then he didn’t qualify for the insurance. And it was still going to be 90 days before the insurance took effect. I found out that if the doctor declared him eligible for hospice, the benefits were to start immediately. He never got any benefits as he died later that night. The lesson here is, once they acknowledge you have a policy, a hospice declaration may help you get benefits immediately.

Thank you, good to know. I am finding out that Long Term Care Insurance is pretty much worthless.

 

[Dd852]

I’m afraid I had a similar issue with MetLife with my mother. Lots of forms and lots of back and forth. Questions and more questions. Forms and more forms. No progress for several months … and then my mother died. The lawyer who helped with the estate did manage to get them finally to refund the final month’s premium she paid but that was the only money we ever saw back. The whole experience convinced me to self insure. I wish I had better news to tell you, but prepare yourself for frustration. Good luck.

 

[harllee]

I’m afraid I had a similar issue with MetLife with my mother. Lots of forms and lots of back and forth. Questions and more questions. Forms and more forms. No progress for several months … and then my mother died. The lawyer who helped with the estate did manage to get them finally to refund the final month’s premium she paid but that was the only money we ever saw back. The whole experience convinced me to self insure. I wish I had better news to tell you, but prepare yourself for frustration. Good luck.

Thanks, this is what I am afraid of. Grrrr. My question is how many hours, days, weeks, months should I put into it before I give up. That is what MetLife is hoping--that I will just give up

 

[Nords]

I have skimmed through Nord's thread. What a time he had managing his fathers assets and his LTC insurance. Fortunately, I already have my mothers POA and have presented it to all the financial institutions and have taken over all her assets. But I am just now starting down the LTC insurance nightmare. One of my main problems is I am age 71 and have an older husband and having to deal with this on top of my own issues (like moving into a CCRc next month) is just overwhelming. I don't know if I will be able to handle all this.

I'm sorry you're going through all this, @harllee.

While you're working with the CCRC and the state insurance commissioner, consider hiring a neuropsychologist to do a detailed assessment of your mother's cognition.

Many times a person with early-stage dementia can still pass the Mini-Mental State Exam and other rapid-assessment tools. Yet at the same time they're completely unsafe at independent living-- both as a hazard to themselves and to everyone living in the same building or near their automobile.

Back in 2011 this doctor's one-on-one visit took nearly three hours and cost nearly $4000 out of pocket... however it immediately cut the red tape with John Hancock. We also had to use the neuropsych's assessment for the guardian/conservator court hearing, so it helped us twice.

 

[harllee]

I'm sorry you're going through all this, @harllee.

While you're working with the CCRC and the state insurance commissioner, consider hiring a neuropsychologist to do a detailed assessment of your mother's cognition.

Many times a person with early-stage dementia can still pass the Mini-Mental State Exam and other rapid-assessment tools. Yet at the same time they're completely unsafe at independent living-- both as a hazard to themselves and to everyone living in the same building or near their automobile.

Back in 2011 this doctor's one-on-one visit took nearly three hours and cost nearly $4000 out of pocket... however it immediately cut the red tape with John Hancock. We also had to use the neuropsych's assessment for the guardian/conservator court hearing, so it helped us twice.

Thanks Nords. Mother is seeing a neurologist who is helping me with the LTCI, how does this differ from a Neuropsychologist? Fortunately I do not think I will need a guardianship, so far the POA I have has been accepted by the financial institutions. Mother does have mild dementia (actually it came on suddenly after Covid and she has been diagnosed with Covid induced dementia) but her main problem is heart failure. She is having difficulty walking and has fallen several times. and is short of breath.