Disability Claims Solutions


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long term care insuranceAt one time Long-Term Care insurance (LTC) was the fastest growing new block of business sold to the elderly. Insurers such as Unum and Mass Mutual quickly designed LTC packages that potentially bolstered profits while Group STD/LTD was in an unprofitable downslope.

As it turned out, LTC insurance quickly became a very expensive product to pay out and after many abuses, mainly with the calculation of inflation factors, LTC insurers dropped the line of business and stopped selling the product, just short of bankruptcy.

Many of my readers might not know that I also help to manage LTC claims and Life and Health insurance. Over the last several years, it has become apparent that many of the “at home health services” commonly used by the elderly, such as “Kindred or Visiting Angels” are not prepared to provide the kind of “proof of claim” now demanded in order to pay LTC claims. I’m getting the impression that so much “evidence” is required, that most elderly persons requiring home care might not be able to “chase it, or provide it.”

Although resources providing home care try very hard to provide the paperwork required, it takes a while to find persons who can accept accountability for getting it where it needs to go. In many cases, home health care and other services are small businesses located in geographical locations far away from their parent companies.

If you are unfamiliar with LTC insurance, it should be said that recipients must show proof of services provided in order to meet the Plan’s Elimination Period. Mass Mutual’s LTC Plan, for example, requires: state licensing information, copies of all invoices, a copy of the Plan of Care, and dates and times services were received. “Days counted” to meet the EP are only days when appropriate home care was provided and proof submitted for those days.

While Mass Mutual’s LTC supervisor was telling me they receive this kind of information routinely, Kindred, for example, told me they didn’t even know how to find their licensing information. Another supervisor at Visiting Angels has put in double duty to try and assist in providing the paperwork, but after a few tries, it still didn’t meet Mass Mutual’s overall guidelines.

I think it’s fair to say that at least with LTC Plans with Mass Mutual, obtaining paperwork to show “CARE” is about as difficult as it can be. I can’t imagine an elderly person, needing home care, could possible meet the paperwork demands of Mass Mutual in order to qualify for benefits. It just isn’t possible without other support.

Unum was nearly charged with criminal activity in California and hasn’t offered LTC insurance for many years. Premium for LTC insurance is quite high and it doesn’t make sense that the facilities providing care aren’t more prepared to provide information when asked to do so. In my opinion, not many people can afford LTC insurance and therefore, requests for information are few.

Those who have already purchased LTC insurance should be aware that most elderly who NEED home health care would not be able to apply and manage their own claims by themselves. It would be very helpful for family, or guardians to know what is involved in applying for LTC, and be prepared to assist when the time comes.

The paperwork requirement from home health hare facilities is out of control and possibly outside the patient’s ability to provide it when the time comes for LTC. Family or POA support may be needed and planned for.

Today, LTC insurance is one of the most risky investments patients can pay for, although the services remain much needed.