Long Term Care Insurance (LTC) is, without a doubt, the most complicated to collect. This is intentional — they do not want to give up any of the money you have been paying them for the past 20 or 30 years.
First, the company hopes you die before you collect. Often the children don’t know their parents have the policy and find it in their belongings after death. The other big mistake is that the seniors or their children call the company assuming there will be assistance . The companies have a name for this group: customer service (an oxymoron). No one in customer service has your best interests at heart. Every person you deal with will give you a different answer and, remember, this is after 45 minutes (minimum) of holding.
Here’s how it works, the parent must have lost 2 of the 7 Adult Daily Living (ADL) activities (place a link listing ADLs). 2 that are common are loss of balance and incontinence. At this point, you call, state you’re unable to perform 2 ADLs and the company will open a claim. Next you have to prove your claim which means that a “nice person” (NOT) from the insurance company comes to ask you questions and asses whether you “really need” LTC. If you’re denied there is an appeal process and it’s cumbersome. If you are approved there is a 90 to 100 day waiting period in which the family has to pay for the treatment. The insurance company will never reimburse you for this and it is not cheap.
You’ve now done the “waiting” period . . . in so doing you have wasted hours finding a care provider, documenting the care and overseeing who they sent. Now, it’s time to collect! Well, LTC doesn’t’ pay until after the treatment is rendered — so the waiting period is actually 130 days (131 if it’s the wrong month). Then there are all the reasons they cannot send you the payment and, no, they don’t accept emails, only regular mail or fax. Every phone call is sent to Bangladesh or the Philippines where the English is difficult to understand and on and on and on. The most appalling part is when they quit paying without notice because they miscounted the days or money or . . . does it matter??? Our company has collected monies for our clients from these insurance companies because of this error — in one case $15,000.
Bottom line – LTC is a must but like every insurance company it must be monitored! These companies do not care about old people or sick people, they care about the bottom line.
And now . . . onto emergency rooms and hospitals.