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Long Term Care Insurance- Claim Denied for Medicare Duplication Our LTC policy clearly states that it covers the remaining balance on Medicare reimbursed medical equipment, but on the phone the insurer said because ours is a tax-qualified policy, that doesn't apply to us, and that we will receive no reimbursement. Also, is the death penalty an option if this insurer is tried and convicted for fraud?

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Please be a little clearer on this question so that we may assist.
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Helen - whatever you filed for from your Tax Qualified LTC policy is NOT meeting the "benefit trigger" to pay. Carefully & calmly review the policy, then call the LTC.

TQ LTC are lots more strict for benefits eligibility than non-QT.
Like a non QT may have it that benefits start once your MD certifies you are unable to perform 2 or 3 out of 6 ADLs at any time; But a QT LTC may have it that you need MD to certify you are unable to perform 3 out of 6 ADLs for at least 90 or 100 or even longer period of continuous days (with documentation in your health chart for the period of time) before you meet the benefit trigger.

Tax qualified LTC - to me - are best done if you are looking at lots of healthy years and its the tax deduction thats whats the more immediate benefit for you. $ 5,110 for 2017 for federal taxes plus whatever your state has atop that. Pretty sexy deduction!

As an aside on this, a few states are looking at doing or are doing state income tax breaks for those who do QT LtC. It's about planning for health care costs as state budgets flat cannot cover the Medicaid costs once the tsunami of baby boomers start needing NHs. If you have a LTC policy, then in theory, it delays you from Medicaid. It shifts costs to the LTC insurer and the policy holder & their family to pay fir or provide care. But in turn, the insurer places strict benefit triggers as to limit their costs.

The devil is in the details in your policy..... on any insurance product, whether it's LTC or an annuity or emergency road insurance.
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I have experience with a two claims for medical equipment with my husband's LTC insurer. Both denied! Now filing appeals. All I can say is that they try to avoid paying for anything except the caregivers.
I would appeal in writing.
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Helen, just checking that you are referring to a long term care policy not a medicare supplemental plan. Assuming you are referring to a LTC policy I would call customer service and ask for a complete explanation. Each insurer has different provisions so I doubt you can get very specific help from this board. Not every response from a call center is correct. Too often the staff isn't well trained and can easily give a pat response whether or not it applies to your situation. Call again and ask for a supervisor. If you get the same response ask where it states that in your policy.
Tax qualified refers to the owner's ability to deduct the premiums as a medical expense and to receive benefits without owing tax on the payment.
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I am confused. Are you referring to Medicare Part B Supplimental insurance? That is the insurance that covers what Medicare does not cover in terms of medically necessary equipment, procedures, doc visits, hospital etc.

Long term care policies cover either in home care...meaning the payment for home health aides, or coverage for the cost or part of the cost for nursing homes. Neither of which are covered by medicare.

So...if you are asking the long term care policy insurance company to cover the remainder after Medicare part B pays  its part....you are asking the wrong insurance policy. Look up the part B supplimental insurance....they cover it.

If it is a Plan F...then anything Medicare approves but only partly covers...the plan F policy covers the rest. If the Part B plan is less than a plan F..then you may not have as good a coverage...of course...the lesser plans are also a lot cheaper premium.
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Helen, when an insurer fails to cover something that the policy says is covered, you file a complaint with your state insurance department or the state attorney general's office.
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Helen, I am moving your post back to the front of the line to see if anyone who has experience with a Long Term Care policy can answer you. I am not familiar with them at all.
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