Koolau
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Here's hoping there is a special inner circle of Hell awaiting those who employ these tactics against insurance clients. Blessings to you, Midpack.Definitely TMI but you asked. In addition to the deliberate stalling tactic I noted earlier - that’s the most blatant and irritating aspect of all IMO:
If you’re thinking the in home hospice days don’t count towards the qualification period because Medicare paid for it, 1) they’ve already agreed to count 9/3 through 11/10, and 2) I’ve read the policy and it clearly states in home hospice time counts with no mention of who paid. They’re ignoring 6/5 thru 9/2 towards qualification period, with NO explanation. Again nothing changed on 9/3.
- Sister was diagnosed with cancer 5/9, metastatic cancer on 5/25/25.
- Declared terminal on 6/5 by oncologist, given estimated 6 months to live and unable to handle enough life functions to qualify for hospice.
- Qualified and started in home hospice 6/5, continued 6 days/week thru 12/10 when she died. About $8500/month all paid by Medicare Advantage (I make no claim for any of that obviously).
- Moved to assisted living 11/10, died 12/10, cost $8600 all out of pocket.
- We submitted the JH application and first invoice on 11/21.
- Her JH policy was to pay $100/day. She spent $286/day.
- Her JH policy had a 90 day qualification period (policyholder out of pocket until then).
- After months of back and forth, on 2/20/26 they told me they’d pay the claim. Said the qualification period started 9/3, so 90 day qualification period ended 11/30, so 11/10 thru 11/30 was out of pocket, and they’d pay a benefit for 12/1 thru 12/10 only. Nothing whatsoever happened on 9/3 with her status or care, and JH hasn’t given any answer why they chose that date, I’ve asked many times.
- Finally paying me $1000 next week, versus the $3000 they owe in my view - she was under hospice care for more than 5 months before assisted living, much longer than 90 days.
All that said, I’m going to accept the $1000 (vs $3000) after more than 4 months of talking to CSR robots who start from square 1 every time I call. So their ‘stall until the beneficiary gives up’ has worked partially.