One is fortunate to be reimbursed in a month's time. However in my mother's situation the LTC would delay every few months because they had sent out reviews wanting to know if patient still needed AL.
While a facility may not accept direct payment from LTC, a good one can handle and expedite the responses in order for reimbursement.
Well I guess it depends where you live, for Louisiana, the Insurance Commissioner traditionally goes to Federal Prison. I kid you not! The current one Jim Donelon has run a good office but by & large if too many complain an insurance carrier will withdraw from the State. It can pay back premiums as needed and leave, or just not do renewals and leave, it’s legal to do in most places. Except for New York State and up in NE corridor, most allow this.
The 3 past Louisiana Insurance commissioners, Jim Brown, Sherman Bernard, Doug Green all went to prison. We right now are amidst a near total melt down on homeowners insurance getting issued for coastal LA & MS as most carriers are not doing renewals. It’s pretty frightening.
lil factoid, Jim Browns daughter is Campbell Brown, writer. She was anchor on NBC wkends abt 20 yrs ago, super nice.
In my personal opinion this is insurance company standard practice. Do whatever to not pay out on a policy. Ever. The LTC have additional issues that a lot of these were done by companies that haven’t existed for decades now (John Hancock sold its LTC unit like in 2011) plus policies based on 1980’s health care.
Fwiw my moms 2nd and much better NH, they had a sign in the entry area that they did NOT take LTC insurance for payment. One day I was topping up moms personal needs account & chatting with billing and asked him why and got an earful: that for them (smallish but well established NH group) it was more cost effective to do private pay, MediCARE and Medicaid only and not deal with LTC insurance ever! as they flat took too long to pay and were forever foot dragging on needing clarification and additional details to process a claim. Lots of back n forth. That his & back central office time to deal with the bs the LTC companies wanted especially on educational info on nursing and therapists staff and their time sheets was crazy town. Not worth doing when the M & Ms pay basically in real time once a facility enters that days bed count. They kept abt 1/3 beds always with rehab patients and that kept them profitable as these were Medicare & easily double if not triple for reimbur$$$ment.
The issue often is - especially for older LTC policies - is that they are written for nursing care based on how care was done last millennium. So policy is for an RN doing in a home visit 30 hrs a week at $18 hr. Lol. With no inflation rider. No way RN charge $18 hr in 2023, so insurance billing clerk or family has do a staffing adjustment waiver to get a CNA for $18 hr OR pay for a RN @ $48hr to allow differential paid. This might be why there is a delay???. I’d look to see if there is a pattern as to the payments, & if so, it’s a paperwork filing that’s happening. There’s a document that has to get approved, then payment happens, that my guess. LTC doesn’t pay forever, so try to find out & soon what the end point is. So that you & the rest of the family are ready for when that day comes.
Also I doubt they would pay weekly on the plan, more than likely monthly. I so agree with you that insurance now takes the stance of "no, we aren't paying" and only after a whole lot of foot work by the insured and their providers, will they cough up the money. They hope that you will be too impaired or too worn down to follow up, esp on smaller claims.
To take the stress out of the situation, look into prepaying one month so that payments arrive on time. If you can set up "auto pay" through the insurance company, that would be great or if not, set up the private auto pay situation where you get the deposit and then autopay the LTCI company. Call the billing dept manager and see if he/she can assist or go to the bank.
Looks like to me when getting a LTC plan you need a lawyer to review the policy. And who would not think that 20/30 yrs ago that there would not be inflation. My daughter makes almost $50 an hour as an RN. When she started out as an LPN she was making $15 an our 25 yrs ago. Worked up to $27 a lttle more than 10 yrs ago. When she got her RN, they raised her to $30 an hour.
My husband is in Memory Care..we have LTC thankfully. I am reimbursed within 10 days but they only pay after care is provided so Im always 1 month behind. He has been in 3 facilities and his current facility is by far the best with submitting invoice to insurance. It may be the facility submitting incorrect information or they are lagging in their billing. The statements I received from other facilities were so convoluted and inaccurate. It took two months for 1 reimbursement to be submitted correctly from the facility. Im sure you get reimbursed monthly but any delay from the facility or questionable care will cause your payment to be delayed.
Write to the State Insurance Commision.
While a facility may not accept direct payment from LTC, a good one can handle and expedite the responses in order for reimbursement.
The 3 past Louisiana Insurance commissioners, Jim Brown, Sherman Bernard, Doug Green all went to prison. We right now are amidst a near total melt down on homeowners insurance getting issued for coastal LA & MS as most carriers are not doing renewals. It’s pretty frightening.
lil factoid, Jim Browns daughter is Campbell Brown, writer. She was anchor on NBC wkends abt 20 yrs ago, super nice.
Do whatever to not pay out on a policy. Ever.
The LTC have additional issues that a lot of these were done by companies that haven’t existed for decades now (John Hancock sold its LTC unit like in 2011) plus policies based on 1980’s health care.
Fwiw my moms 2nd and much better NH, they had a sign in the entry area that they did NOT take LTC insurance for payment. One day I was topping up moms personal needs account & chatting with billing and asked him why and got an earful: that for them (smallish but well established NH group) it was more cost effective to do private pay, MediCARE and Medicaid only and not deal with LTC insurance ever! as they flat took too long to pay and were forever foot dragging on needing clarification and additional details to process a claim. Lots of back n forth. That his & back central office time to deal with the bs the LTC companies wanted especially on educational info on nursing and therapists staff and their time sheets was crazy town. Not worth doing when the M & Ms pay basically in real time once a facility enters that days bed count. They kept abt 1/3 beds always with rehab patients and that kept them profitable as these were Medicare & easily double if not triple for reimbur$$$ment.
The issue often is - especially for older LTC policies - is that they are written for nursing care based on how care was done last millennium. So policy is for an RN doing in a home visit 30 hrs a week at $18 hr. Lol. With no inflation rider. No way RN charge $18 hr in 2023, so insurance billing clerk or family has do a staffing adjustment waiver to get a CNA for $18 hr OR pay for a RN @ $48hr to allow differential paid.
This might be why there is a delay???. I’d look to see if there is a pattern as to the payments, & if so, it’s a paperwork filing that’s happening. There’s a document that has to get approved, then payment happens, that my guess. LTC doesn’t pay forever, so try to find out & soon what the end point is. So that you & the rest of the family are ready for when that day comes.
the Assisted Living my Mom is at has been so good about billing. They now send it by email as the company kept claiming they weren't getting the fax.
i am copied on the email and there has been no more hanky panky.
keep an eye in these companies, some are difficult such as the one my parents had.