Long Term Care and Dementia

[Mike Chance in Iowa]

Looking for input on this subject from those with experience or knowledge in LTC policies. Mother-in-law was diagnosed with dementia awhile back. We moved her into a Senior Assisted Living Facility last year after she flooded her apartment. She is still mobile and dresses herself and keeps her studio clean. She eats her meals in the dining room but can make a peanut butter & jelly sandwich. She cannot manage her medication routine and the facility brings her meds multiple times a day. She will ask the same questions over and over within minutes. She is unable to manage her medical, financial and daily decisions. She has difficulty answering what her name is and tells a long story on how her name changed at baptism and marriage, yet never really directly answers "Jane Doe." She has difficulty with time. If we visit her directly after her lunch, she will tell us she needs to get ready for dinner - which is in 4 hours. The list goes on and on.

We have been attempting to initiate a claim for her LTC since January 8 and have been receiving the run-around for months. It took us 3 months for them to approve Power of Attorney. In March, they finally sent out a representative to do a cognitive test on her which was so incredibly simple, it was clearly designed to deny any cognitive issues. (The nurse testing her even commented on how she had not seen a test like this.) Not surprising, when calling them last Friday to ask what is the status of the claim, the out-sourced foreign call center person said her claim was denied based on their evaluation. They never bothered to contact her doctor or read the letter from her doctor.

Mother-in-law's LTC policy has a benefit eligibility criteria of: You need substantial assistance from another individual to perform at least 2 of the Activities of Daily Living due to loss of functional capacity; OR You need substantial supervision due to the presence of a severe cognitive impairment.

The way my LOML and I read this, it means you are physically incapable of eating/dressing/bathroom/mobility OR you have cognitive issues. It does not mean you have to have dementia and no longer be able to dress or feed yourself. Is that correct?

We plan to appeal their determination, but we are not certain if submitting the appeal form, with a document listing all the cognitive issues she is having, and her doctor's cognitive assessment, and letters from two doctors will be enough. Considering how difficult this LTC company has been to deal with all these months to even receive paperwork to initiate a claim, we think they are going to come back with some other reason to deny it so they can keep the money for profit.

Any advice on how to deal with this or is she truly not "severe" enough in cognitive decline because she can still dress and feed herself?

[Jeff Roltgen]

My BIL was able to feed and dress himself until pretty much death. He had no LTC policy. Your MIL is displaying similar behavior, and he was of similar competency within 6 months leading up to his passing. While we had no claims to process, I can tell you getting him into a facility was 12-18 month wait. Until he started having seizures. Landed in hospital - ready to send him home 3 days after anti-seize meds seemed to have things under control. Couldn't get him to the door of the hospital to leave before yet again, seizures began. After 10 days of hospitalization, they placed him in a home, as they determined we were no longer able to care for him after 5 years in our residence, based on special meds/observation needed and lack of wheelchair accommodations, etc. Prior to that, we were given lip service and put on a waiting list, as far as getting him into a facility. Seems there's a trigger in the system somewhere, and they need to see it hit before proper action is taken. Hospitalization makes a very big difference when trying to place someone into a memory care facility.

What I can say about a LTC policy, which naturally under the circumstances we were curious about ourselves, it looked like an insurmountable expense, like $650/month for the two of us, payable until we pass from this earth. Continued communications with that agent revealed that a year after our inquiry, a policy was no longer available, as they were over-sold and over-obligated to pay, and suspended issuing new policies. In light of this, it appears your carrier has likely a similar scenario, and may indeed push back as hard and for as long as possible, due to the excessive drain these policies generate once payout begins. Just my opinion, FWIW.

I feel for you, as this is very tough stuff to deal with. I hope not needed, but in establishing power of attorney/executor status, you'll need a lawyer anyhow, and perhaps you may find their assistance valuable as you smooth out this process of dealing with your in-law's current stage of the disease. Sometimes a simple show of authority from your end may prompt a change of tune from the insurance company, as this sounds like it's right on the edge of them acting in "bad faith". Sometimes, only a compassionate, local legal counsel can help you.

You have my sincerest sympathy, and I wish you and your spouse emotional strength during this stage of mom's life.

jeff

[Mel Fulks]

I’m sorry ,that’s a terrible thing. It’s plaque in the brain….so I’m brushing mine with Crest… It used to be “old age” , now people in their
forties are getting it. There might be places nearby that have supervised “day rooms”, where she might have access to new friends and
activities . But that’s just a temporary help. There are people in their 40’s who are still working and
wondering what’s happening to them, but scared to find out.

[Mike Chance in Iowa]

Thank you for the support. Sadly, I have heard of other people struggling with hospitalization and seizures like you dealt with.

The name of the LTC company seems to be a "big name" brand. MIL used to work for insurance companies for most of her adult life as a typist, so they seemed to have set their employees up with a good policy. We totally lucked out with finding a Senior facility for her after she flooded her apartment. Many residents were being moved out to their family homes due to Covid so a studio unit was available. This facility can handle anything from Senior Independent Living to end of life care. The only time they have to move a resident out is when they become a danger to themselves or other residents because they do not have passcode locks on their doors like a memory care facility does. We do really like the staff working there but they are only fluent in LTC policies that involve physical needs. Their LTC expert left to have a baby and be a stay-at-home mom for now. The waiting list for Medicaid support is years though.

What we have learned about the LTC company is the few letters we have received seem to be from a fictional person and all calls are answered in a call center where English is not their first language and they clearly read from scripts. When you ask to speak to someone in the US, the people that do answer in the US seem to be bothered with having to answer a call. They don't correspond online. It is all done via postal mail or fax. Oh, but they are more then happy to promote their online system in paying the $$$ monthly premiums!

MIL's care is costing over $4k a month and her monthly Senior income does not cover it. She has about $400k available in LTC funds and she could use it now!

Anyone with some guidance on how to proceed with her denied claim appeal will be greatly appreciated. I think they have severe cognitive impairment vague just so they can deny claims.

[Bill Dufour]

LTC policies often are time limited. Like they only pay for 3-5 years total.
Bill D.

[Scott Winners]

ADLs, the Activities if Daily Living are stuff like dressing your self, feeding your self, dressing yourself and bathing yourself. The IADLs, Independent Activities of Daily Living are stuff like cleaning the bathroom, cooking, doing laundry, organizing medications.

You might look up the FAST scale for dementia assessment. Sometimes my patients will skip around a little bit, like on a bad day that might be a 7b, and then have several good days in a row where they might score 6b or 6c.

Substantial supervision, (I am an RN, not an insurance company employee) is not defined to me. Under MediCare guidelines would be grandpa taking the breaker box apart in the middle of the night without turning the main breaker off first and requiring constant supervision, or someone else who likes to wander so far from home they get lost and cannot tell anyone their home address. For the latter, a door alarm and routine supervision might be appropriate.

For her coverage to kick in now, without my having done an exhaustive chart review, met the patient and then taking your statements at face value; it sounds to me like she is currently independent in ADLs. She does need probably routine (MediCare defined) supervision, "substantial supervision" I don't know the definition of, but it doesn't sound like she needs (MC defined) constant supervision. Folks who pull out their urinary catheter 2-3 times per week, without deflating the balloon first, require constant supervision.

Hope this helps at least a little, these are never easy.

[Jim Becker]

I feel for you...my mother was in a similar situation and I was thankful that my dad and her made the fortunate decision to buy into/endow into a life care community that had stepped services, especially when she initially needed to move from independent living to assisted living and later to skilled nursing before she passed away. And she did have dementia. Scott just provided some valuable input for sure.

At any rate, I'm sad that the LTC insurer is giving you the runaround. In the US, insurance is regulated by each state, so one place you want to touch bases with is your state insurance board/department/agency. Hopefully, they can help light a fire on this situation as a direct legal approach can be difficult sometimes.

[Tom M King]

Elder care is going to be a growing issue every year to come. My Mother was completely independent, living by herself, until she was 102. She had a stroke that she mostly recovered from, but lived in independently in an Assisted Living facility for a little over a year and a half, and then had another stroke. That facility was 4k a month, and her other expenses were another couple of k.

After she second stroke, which left her paralyzed on her left side, she would have had to go into a nursing home that would have been $9,800 a month, not including her other personal expenses, so we brought her home with us. I'm fortunate to be almost 72 years old, and still able to pick up a 120 pound person, but it takes my Wife and me to do all the handling required. For this reason, I can no longer work away from home, but am fortunate to have plenty to do here, a minute or two from the house.

She is still clear headed, and putting her in a nursing home, which are pitiful at best, would have been like torture to her. She actually enjoyed the Assisted Living faciity because there were enough other people there who still had their normal intelligence and personalities that she enjoyed their company.

A couple that I redid a mid 19th Century house for, that was their dream to enjoy after their retirement, had a Dementia problem. The Husband had retired a couple of years before his Wife did. She had been hiding her dementia well enough that no one knew. They were both heads of departments at a major university. Soon after the Wife retired, it became obvious that her mind was fading fast. It very soon got to the point that the Husband could not care for her, and she had to go into a facility where she was locked in. She would wander off at home, and get lost, so she needed to be constantly watched. Now, five years later, she doesn't know who anyone is anymore.

I wish everyone luck who is fortunate enough to have elder family members. You never can predict how it will end up.

[Malcolm McLeod]

Thank you for the support. Sadly, I have heard of other people struggling with hospitalization and seizures like you dealt with.

The name of the LTC company seems to be a "big name" brand. MIL used to work for insurance companies ....

You are on a tough road and have my profound sympathies. It is one I have been down twice, and another 1 or 2 in the works. If you have not been in a memory care facility, brace your feet; it is a gut shot.

Can't help on implementing the LTC policy, but will just advise anyone to RUN from Allstate - for anything!

[Edwin Santos]

ADLs, the Activities if Daily Living are stuff like dressing your self, feeding your self, dressing yourself and bathing yourself. The IADLs, Independent Activities of Daily Living are stuff like cleaning the bathroom, cooking, doing laundry, organizing medications.

You might look up the FAST scale for dementia assessment. Sometimes my patients will skip around a little bit, like on a bad day that might be a 7b, and then have several good days in a row where they might score 6b or 6c.

Substantial supervision, (I am an RN, not an insurance company employee) is not defined to me. Under MediCare guidelines would be grandpa taking the breaker box apart in the middle of the night without turning the main breaker off first and requiring constant supervision, or someone else who likes to wander so far from home they get lost and cannot tell anyone their home address. For the latter, a door alarm and routine supervision might be appropriate.

For her coverage to kick in now, without my having done an exhaustive chart review, met the patient and then taking your statements at face value; it sounds to me like she is currently independent in ADLs. She does need probably routine (MediCare defined) supervision, "substantial supervision" I don't know the definition of, but it doesn't sound like she needs (MC defined) constant supervision. Folks who pull out their urinary catheter 2-3 times per week, without deflating the balloon first, require constant supervision.

Hope this helps at least a little, these are never easy.

I agree with your explanation as industry norms, but Mike may need to look at the fine print in the policy and see if the carrier specifically defines ADLs.
Coverage triggers are usually very explicitly defined and may or may not mirror common industry definitions. Usually they're more restrictive, no surprises there.

[glenn bradley]

With the fundamental understanding that the insurance company business model runs on premium collection and not service provision I am sorry for your troubles. This is a good reminder to all of us to take responsibilities for such things lest they fall to our children. I don't think any of us would wish Mike's sitch on our kids. I will be watching with interest and wish you good luck.

[Mike Chance in Iowa]

So do you all think she has to have both conditions for her LTC? The way we read it, it's an OR situation. That she does not need to have issues with ADL in addition to her dementia.

Thank you all for the information. Any and all helps! According to the primary doctor that specializes in Senior care, she said she can tell the "smart" people because they have creative ways for making up for their lack of memory. Such as my MIL giving a detailed answer on how she stores all her pills in pill organizers 3 weeks in advance. The question was "What time of day do you take your medicine?" and "Do you take X medicine on an empty stomach?" (She was skipping daily meds, as well as taking too many on some days and her pill organizers did not have the same quantities in them.)

It's John Hancock LTC. A quick google search shows they have many 1-star reviews and how reluctant they are to pay claims. They no longer sell LTC.

I have dealt with several people with cognitive issues in their 80-100 years of age but never dealt with initiating Long Term Care claims. I agree. Going into a Memory Care Facility is rough. Cleanliness is not a high priority in many of them we looked at.

[Bruce Wrenn]

There are attorneys who specialize in theses types of cases. Most want a large cut of proceeds though. Start with state insurance dept. AARP is also a good source of help sorting through these type things. Basically, insurance company is telling you to GO AWAY, as a claim will hurt their bottom line. You, or your mother paid the premiums, but insurer thinks it's their money.

[Howard Pollack]

In many localities there are people who serve as "long term care ombudsman". They are often employed by the local department of Social Services. That same department may be useful to consult with as they, even if they don't employ such an ombudsman, have undoubtedly run into this problem many times before. Also the state may have a department of insurance who might be helpful or steer you to help. Some of the local non-profit groups who provide help and information regarding aging may themselves have advice or have a lead on a pit-bull attorney who knows how to deal with this way to common problem. Best of luck -Howard

[Bill Dufour]

My mother lived to be 97 and 3/4. We had to put her in a home. It was interesting because we talked about her early life. At first she remembered her college days and early thirties. I learned interesting stories I had never heard. She never forgot her early school days.
I think it calmed her down to talk about the old days, which she could remember. At the end she did not remember living in the family home for over 50 years but she remembered her childhood home. She told me they closed the streets at lunch time so the kids could run home for lunch. A water truck came by once or twice a week to fill a cistern with good water for one faucet in the kitchen. City water was not very drinkable. I found out only 10 years before she was born the city water came in by train in the empty wood oil barrels being returned for filling.
Bill D

[Thomas McCurnin]

+1 on Bruce's answer. Having worked in risk management for several major corporations, the whole business practice is to deny claims on any plausible basis, and with some luck, the claimant will go away. Granting claims will not make the insurer a profit and may impact whether dividends can be paid that year. Read the policy to determine what your rights are, and what procedures you have to follow before lawyering up. My assumption is there a claim process, an appeal process, and perhaps a second appeal process before having standing to file suit. If you are not good with reading such documents (try reading with a ruler or reading aloud on a sentence by sentence basis), then by all means give the document to a professional (lawyer) who is familiar with those things. I used to practice law in Iowa, so PM me and I may be able to give you a referral depending on which of the 99 counties you guys live in.

[jared herbert]

I see you live in Iowa as do I. Years ago I had a grandparent that had a similar problem, insurance company refused to pay her valid claims. The company had her buffaloed for some time but my aunt eventually figured out what was going on. A call to the state insurance commissioner and the problem was solved quite quickly. I hope your problem can be solved like this. Insurance always seems to work very well as long as you are paying the company but it seems like the reverse doesn’t work so well.

[Tom M King]

How is elder care handled in countries that have universal health care? Maybe some of our Canadian members know.

[Michael Schuch]

So do you all think she has to have both conditions for her LTC? The way we read it, it's an OR situation. That she does not need to have issues with ADL in addition to her dementia.

Thank you all for the information. Any and all helps! According to the primary doctor that specializes in Senior care, she said she can tell the "smart" people because they have creative ways for making up for their lack of memory. Such as my MIL giving a detailed answer on how she stores all her pills in pill organizers 3 weeks in advance. The question was "What time of day do you take your medicine?" and "Do you take X medicine on an empty stomach?" (She was skipping daily meds, as well as taking too many on some days and her pill organizers did not have the same quantities in them.)

It's John Hancock LTC. A quick google search shows they have many 1-star reviews and how reluctant they are to pay claims. They no longer sell LTC.

I have dealt with several people with cognitive issues in their 80-100 years of age but never dealt with initiating Long Term Care claims. I agree. Going into a Memory Care Facility is rough. Cleanliness is not a high priority in many of them we looked at.

Such organizations specialize in giving people a run around. It IS their business model!
1) Document everyone you speak to. Date/Time of the call and persons name.
2) Record all calls if you are able to. In Oregon only 1 party has to know a call is being recorded for the recording to be admissible. Even if a call recording is not admissible in court it can be very helpful.
3) Google "File complaint against insurance company in {your state}"
4) File complaints through ALL possible agencies, not just the first one to pop up.

There are agencies out there that are supposed to assist people getting the run around from insurance companies. Make friends with them, they are your allies not the people giving you the run around.

I don't believe I shared my story here about my internet problems. I spent nearly 10 years battling Centurylink over Internet connectivity issues. 2 weeks after I filed complaints with the FCC, PUC and Oregon state attorney general I have a new cable between the street and my house. Trying to get anything done through Centurylink itself is the definition of ineffectual.

https://www.hobby-machinist.com/threads/fcc-opened-a-case-against-centurylink.99156/

Personally, I would ONLY contact a lawyer after all other avenues have been exhausted.

[Stan Calow]

The LTCPs we looked at required you to meet at least two of the five conditions to qualify for payment. We dropped it when the annual premium tripled at age 65.

[Mike Chance in Iowa]

Thank you again for all the suggestions! I will be reading the link later about the FCC and internet. The first post sounds is very similar to what we have been going through since moving to this property in 2014.

I have been on calls for most of the day so far. I found a phone number for a Plan Administrator near the back of MIL's policy. The woman who answered said I needed to call a different number for the Benefits & Resources. Understandable the number changed with it being such an old policy. After reaching Benefits & Resources, there was no LTC option in the phone tree. The "other reason" representative was extremely helpful, but she was having a lot of difficulty finding anything on LTC. She found a number to call John Hancock and when she called it, a casino that answered. She finally found some info stating their company no longer managed LTC plans. Reaching out to her supervisor, they put me in touch with someone who is going to try to find a US based contact with John Hancock and will get back to me later whether she has an answer or not.

I gritted my teeth and called John Hancock again. All their calls typically involve at least a 20 minute wait time before anyone answers. I asked to be transferred to someone in the United States. When I reached someone in the US, she too was from a call center. I asked for documentation that defines "substantial supervision for a severe cognitive impairment" and she said there is no documentation. That she could mail me a copy of the policy. I told her I have the policy in my hands and there is no definition of what "substantial" and "severe" is. She did say this policy is set up to trigger with either the need for 2 of the ADL OR "severe cognitive impairment." It does not need to be both. I asked her what needs to be provided in order to claim her cognitive impairment. Her answer was "A letter from her doctor stating she has dementia." I already faxed that letter to them on 3/10/22. This girl was not making policy decisions. Her job is to answer calls for probably dirt cheap. She tried to be helpful and really encouraged me to fill out the appeal documentation.

The next step is I am waiting for the doctor (DNP) and her boss (MD) to write their letters indicating MIL has dementia and needs supervision. They will have the letters notarized. Then I will fax the letters and the appeal letter to John Hancock. Instead of an appeal letter, I'm creating an itemized list including dates. Things like She responds with "Yes Mommy" and "Yes Daddy"; She can't manage her daily meds; She cannot remember what food she ate for lunch 15 minutes ago; She does not remember how to lock/unlock the brakes on her 4-wheel walker, etc. I'm up to 47 items so far. Both my LOML and I will sign the appeal and have it notarized for good measure.

Since I am self-employed, I'm the one with more flexibility in my schedule to make calls, meet with Senior Facility staff, as well as run MIL around to her various appointments. Dealing with all her finances and medical insurance and life matters has been fairly easy. Dealing with Long Term Care is turning into a full time job for me.

I agree 100% about documenting everything including what number was dialed. I kept casual call notes when I started managing all her care, but once I started dealing with John Hancock, that all changed.

I will update this when I have more information and/or progress. It's going to be useful for someone else at some point.

[Bruce Wrenn]

Food for thought, Social Security is a form of elder care. Grips me to have to pay taxes on half of it, when for most of my working life (self employed) I couldn't deduct payments from my gross income. Tom, I'm sure you are in the same boat.

[Warren Lake]

Tom I wrote a paragraph or two last night and deleted. If our education system was smart it would have taught us things we need to know and one of the most important would be elder care, a thing we will all face. Ive done that from late 2015 for my mom, then the old cabinetmaker then back to my mom. One of his sons died at 32 and the other was scizophrenic, he had no one but he had already become my father long before. A thing that happened without either of use realizing it. Or maybe he tricked me, he was the smartest man ive ever known. I stopped working and was there for them. Id the same again only better now that ive learned so much.

After he passed focused on my mom and his son. Been a long road and lucky for the most part but you have to be on the system all the time. If an elder doesnt have an advocate for them constantly I hate to think what would happen.

I may write up more. It was all learn as I go. A doctor who was not smart caused damage to my mom with his bad choice. Then a doctor at a top hospital in Toronto that was very smart we worked and he solved the issue. If any of you know anyone that is having mini strokes make damn sure you get them checked for sleep apnia. Once that was figured out there was never another mini stroke for years till the end. Too bad some damage had been done from the past.

Im not much for labels, even after my mom was labelled with Dimensia around 90 she great to 94 1/2. More sane than any woman in my family and a better memory than me. She was joy, covid made a number of new challenges and it nearly killed her keeping us away from her. Then a whole adventure from that alone too long to go into. It became very clear the only reason she stayed alive was that one of us was there every day. Lucky we were in a good Long Term care home. We had tried three Retirements to get to one which did the job but mom labelled it as a clip joint. Another one we tried first she said she thought it was fake, I looked at her and said it reminded me of Las Vegas and got a smile.

Mom ended up in a different area so we no longer went to that one top Toronto Hospital so even hospital care changed and had to watch that. We nearly lost her one night just because of an emergency room doctor who wrote her off. A CCAC lady and Geriatric nurse listened to me that she had bounced back from stuff in the past they over road the doctor. Didnt even know that was possible but when I said we have to learn the work the system we do.

Three weeks later She was ready and being sent to a new Dimensia home. When I picked her up a nurse told me she didnt want to give her back. How nice was that.

The Dimensia place was great but it cost a Martin Table saw. Lucky in one week got a call and had to move her to long term. That was a blessing. The home was no hell but the group of ladies were amazing and worked together so well. We had many more good years. All that after emergency room guy wrote her off.

For Long Term the system is broken. The Pellicans that run it bring in some gaggle of people every year. Helps get them votes. So lets say 350,000 new people come in. There are not even enough spaces in Long Term for the people who have worked and paid into the system their whole life. Right now the niece that helped me care for the old guy is barely keeping sane caring for a mom with Alzeheimers in her family home. Her mom should have been in long term likely two years ago. She has seen a friend she taught the whole process get their parent in faster. o she is away from her family and has to hire full time to be able to get back to her own home and be with her husband or son. She is a tough woman and still has broken down some times.

I didnt read all above but there are days of the week up here there is an Employment law show. Infomercial I guess but the people are are smart as hell. Background one of them was in the system so knows the inside and out of how the companies avoid paying. I dont listen to it but past times it was on and I heard a bit it was clear alot of companies have to stop playing the game fast. When a lawyer who came from their side of the fence and is smarter than them is involved amazing how fast things change.

We have to fight for too much stuff in life that is supposed to be there to take care of us. Someone posted above who they contacted and things shaped up.

Ive had to stand up to too much over the years but stuff learned taught me enough I could help others.

I once had a lawyers ongoing propane pricing cut in half. He had fought with them and got no where. He was too nice, I stooped to their level.

In the years after if i hired him he refused to bill me.

[Mel Fulks]

Warren, good work there. I’ve written ‘term papers’ that were shorter….that’s how I “broke into woodworking ! “. You are a good son and
friend.

[Murray Roblin]

Hi Bruce,
We're beginning this process for a family member. Stroke, healing but still substantial care required. The financial advisor who helped us acquire the policy suggested documentation, escalation, and plan to use a lawyer. We shouldn't expect it to go to court, just that the insurance company has a calculus for how much the payout will cost them vs. how much trouble we cause.
As someone above noted, LTCs with the benefit structure we have are not being underwritten now.
Best to you.
Murray

[Warren Lake]

For some ball park numbers here Retirement homes are around or were approx 4,500.00 a month, it varies around and money goes up for every little thing. Dimensia care place would have been over 7,000.00 a month. The long Term Care is gov funded so they pay part and that cost 2,700.00 per month.

[Jim Becker]

For some ball park numbers here Retirement homes are around or were approx 4,500.00 a month, it varies around and money goes up for every little thing. Dimensia care place would have been over 7,000.00 a month. The long Term Care is gov funded so they pay part and that cost 2,700.00 per month.
That's consistent with my experience with my mother...and I was thankful that the 'rents did the endowed entry to the life-care community and that greatly mitigated care costs as her needs progressed. One other note about this is that after a period of time, there may be eligibility for some help from Medicaid, depending on the state, etc. In Florida where the 'rents lived, that could only kick in after a year if needs could be proven.

[Scott Clausen]

My sympathies on anyone going through this. To the OP I think it is time to lawyer up to get their attention.

On a similar note I have done a lot of reading on alzheimer's and the relationship with diet, possibly. There are some the are calling it type III diabetes now. The thinking is that ongoing high insulin levels from a high carbohydrate diet that cause insulin resistance and later T2D lead to the plaques. I will be gone before the science is in on this but have switched to a very low carb way of eating just in case it proves out.

[Warren Lake]

15 years ago coast to coast late night made statements that all our health originates in our gut. They have looked into all kind of illnesses originating there and made discoveries. Heard we have brain neurons there? Dont get that however they say promising finds and learning going on.

[Michael Schuch]

Thank you again for all the suggestions! I will be reading the link later about the FCC and internet. The first post sounds is very similar to what we have been going through since moving to this property in 2014.

My Internet connection struggles are pretty irrelevant. The point I was trying to make is that as long as you stay in their system, the system they setup to road block you at every possible turn, you will not make ANY progress. I HIGHLY recommend that you reach out to your states equivalent of the Insurance Regulation Commission and any other state agency that looks like they could possibly be of help. With some muscle that can impose fines or even shut them down behind you it is incredible the progress you can make!

A lawyers job is to make money off of you. A state agencies job is to look out for YOUR interests! I DEFINITELY recommend contacting all possible state resources before getting a reaming from a lawyer as well as the insurance company!

Edit: HERE YOU GO! Start with this online site to file an online complaint with the "Iowa Insurance Division!". For a 15 minute investment you may make huge amounts of progress:

https://iid.iowa.gov/insurance-consumer-complaint

2nd Edit: Also file an online complaint with the Iowa Attorney general:
https://www.iowaattorneygeneral.gov/for-consumers/file-a-consumer-complaint/complaint-form

File complaints with both at the same time and any other agency that you can come up with!

[Mike Chance in Iowa]

Time for an update so this can potentially help others fighting with LTC in the future.

Looking at the advice posted here, as well as talking to some local people who deal with LTC claims, before jumping straight to a lawyer, we gathered documentation and submitted John Hancock's appeal document. I submitted 2 letters from 2 different doctors who specialize in senior care and dementia. They both clearly indicated my MIL has dementia and possibly Alzheimer type and that she is in need of full time supervision. (We talked about brain scans, strokes, etc and the primary doctor is working on setting up those referrals.) John Hancock's appeal document has small sections to state the reasons why we are appealing. We created a 4-page document with a numbered list indicating many Dementia/Alzheimer behaviors she is displaying and included dates when many of them happened. (i.e. Forgetting her name or how to spell it; responding "Yes Mommy" and "Yes Daddy", Unable to manage her meds since X date, etc.) My LOML and I both signed that document and had it notarized.

After submitting the documentation & cover letter using 2 different methods, I called them 6 days later to confirm they received it. I asked for a US representative. She confirmed it was received and that a confirmation letter was generated "today" and would be mailed from the Appeals Dept. No surprise, we have yet to receive the letter. Once again, we all know the person answering the phone was a low-wage call center. She is not to blame. She confirmed that all that it should take to trigger the LTC is a letter from her doctor indicating she has dementia and that she does not need to have two ADL issues to qualify. In a roundabout way, she responded that the doctor letter sent on 3/10/22 was ignored because they deny all initial claims.

She also said that the Appeals Dept will take the FULL 30 days to respond on whether or not they accept the claim. They will not approve it any sooner. The actual policy documentation says they decide "promptly, and usually not later than 60 days...."

Today I have been working on the Qualification Period portion of the policy. The policy has a 90 day Qualification Period before they trigger the benefits. The US rep said the Appeal Dept will determine what date that will be. It could be the June/July 2022 date they approve the claim, or in March when I was finally able to upload a claim, or potentially as far back as January when I started this whole nonsense. I am gathering proof of payment and invoices for the Long Term Care facility dating back to June 2021 just to have it ready for another fight. The actual policy says "in no event will the date determined be earlier than 12 months before the date we receive your completed authorization form." The policy also indicates John Hancock will provide an "approved authorization form" to fill out for the benefit trigger, yet no surprise, they never mailed that out either. Nor is it available online. Which once again requires another phone call while being stuck on hold for 30-50 minutes before someone outside the US answers. :mad:

Once again, we are documenting everything we do with John Hancock.

[Michael Schuch]

GREAT JOB!!!! I sympathize with the ton of effort and extraordinary patients all of that took! Please let us know how it all plays out. Please keep in the back of your mind the state agencies that are supposed to be there to help you out in such situations if your current efforts are not successful! Having all the documentation that you are currently collecting will be huge asset if you need to proceed to a state agency or a lawyer.

[Ken Fitzgerald]

Mike, my sympathies for the entire situation from your MIL's conditions to the bureaucratic situations being forced on you by an insurance company who is/or more than happy to expeditiously take your premiums and pay out in very resistive, stalling manner. You sir are a patient, considerate man!

[Mike Chance in Iowa]

Time for another update so this can help out others in the future. I'll try to make this a cliff notes version.

John Hancock finally approved the claim in June, but instead of going with the mountains of proof provided that the qualification period has already been met nearly a year ago, they set a fictional date so that we had not met the 90-days and would still need to pay the premium for another month instead of paying the $16k owed to her. Another battle ensued with them, thoroughly frustrating everyone involved. John Hancock once again claimed they didn't have the necessary proof from the doctors or care facility.

The care facility gave me the email address of the people that kept requesting the same documents over and over. It was an outsourced company. John Hancock denied having anything to do with them. I tracked down the company on the East Coast and called them. Sure enough, they are hired to gather medical records for John Hancock and said that instead of JH requesting all the documents at once, they dole out the requests slowly over a matter of weeks. This makes the outsourced company look bad because they have to keep pestering the same people over and over again for different documents. When I confronted JH about talking to the company, they suddenly had all the necessary documentation. Yet, mysteriously, they still needed my MIL's doctor to fill out forms and return them. John Hancock never sent the doctor the forms. The doctor made multiple calls to them and provided her contact info and they never sent it. I told them to send me the forms and I will personally deliver them to the doctor. I never received the forms either.

I finally had a "Senior Claims" contact person to work directly with at John Hancock, but days would go by before he would respond to a call or email. He will take up to two weeks to respond.

While dealing with customer service and the so-called Senior Claims Representative, they have let it slip that they have already received the documents all the way back in March 2022, they know she does not need proof of ADL issues, and they see my MIL qualified back in June 2021.

John Hancock deliberately makes it impossible to speak to anyone but their outsourced call center. After waiting on hold for 30-60 minutes for them to answer, you can then ask for a US representative. You eventually have the pleasure of speaking to the same 3 people in the US and their mission is to tell you to read the policy and hang up. You cannot speak to a supervisor. You cannot speak to the Claims Department. You cannot speak to anyone in the Appeals Department. The call center is unable to transfer calls. The main corporate John Hancock office receptionist is also unable to transfer any calls and can only tell you to call the call center. She does not have a company directory. All you can do is fax a complaint form. Each time I have faxed the complaint form, they will mail a form letter from the fictional Peter Burke that says they are waiting for documents and if you don't provide those documents, they will close the case in X days. Even if you submit a complaint that says you want to speak to a real person, and have either not received their forms, or have provided the necessary proof on X, Y and Z dates, they will mail a form letter from Peter Burke saying they are waiting for the same documents they have already received and approved.

Finally in mid-July, the doctor wrote a fabulous scathing letter to them but even weeks later, they claimed they were waiting for proof from the doctor! I could have pushed for payments dating back to June 2021, but all along, all I have been asking for is January 2022 when I first started this whole nightmare. They set her approval date for 12/1/21 and the 90-day qualification date to be 3/1/22. I was not surprised to see they made a calculation error on their payment and started the refund date for 3/7/22. They have also continued to withdraw the now "waived" premium payment from her account and I had to contact them multiple times to request that they return that money immediately. While they can automatically withdraw from her account, they claim they can only mail a check to repay those funds they withdrew. I will know in a week if they withdraw the August premium from her account.

While talking with our vehicle insurance rep, she asked me how things are going with John Hancock. She knew I had been battling with them for months. She told me she just learned that her friend is going through the EXACT SAME THING with John Hancock Long Term Care with her parents. Her father worked in facilities for an insurance company for 30-40 years and thought he had set up all sorts of insurance for him and his wife. They moved into a Senior facility and the wife has dementia. The daughter's story is nearly identical to mine and during the same time period. She too has learned to document everything and only deals with the call center.

I have never had a company make my blood boil the way John Hancock does.

[Kev Williams]

Sorry to hear of the complete and total BS you and yours are suffering thru. I won't be of much help because Medicaid took care of my parents, which was fair PIA itself but NOTHING like you're going thru...

But I am thankful for reading this, because I do know for absolute certain who NOT to call for any type of insurance...

Best of luck --

[Ronald Blue]

Mike doesn't Iowa have a department of Insurance that you can contact? I might have missed that earlier in the comments but this sounds like something that they would get involved in. Just a thought. Sounds like an absolute nightmare for you. Sorry it's been such a long protracted battle.

[Edwin Santos]

Mike doesn't Iowa have a department of Insurance that you can contact? I might have missed that earlier in the comments but this sounds like something that they would get involved in. Just a thought. Sounds like an absolute nightmare for you. Sorry it's been such a long protracted battle.

Second on this. I have had one or two instances where a call to the State Insurance Commissioner's office got some results. When the regulatory side of the carrier hears from the Insurance Commission sometimes things will magically start happening. This varies state to state, but worth a try. All the best,

[Bill Dufour]

I had a problem with my Kasier health insurance. They keep changing the monthly premium for no reason and finally stopped sending a bill for a few months. I figured I had generated over payments. Then they sent a backdated letter claiming 60 day notice, it arrived one day after the supposed 60 days, saying they would cancel my insurance for no-payment.
I ended up contacting the state insurance commissioner who had hear it before. they switched who took in the payments and they cashed my checks but did not credit my account. Never did get any notice of what my monthly premium was. But it became the same once they started sending me a bill again.
It was much easier to contact the insurance commissioner and easier to deal with as well. You tried with your company now just ask the state to step in. That is why they exist and why you pay them taxes. Let the experts deal with it.
Bill D

[Stan Calow]

This pisses me off just reading about it. Talk to an Elder Care attorney, and see if they have some advice. More expenses, but this is ridiculous. The insurer is going to find some way to raise her rates to the point you cant afford it and give up.

[Ronald Blue]

Here's a link to the Iowa Department of Insurance.

https://iid.iowa.gov/contact

[Michael Weber]

I certainly feel less guilty about not buying LTC insurance decades ago after reading this thread. What an awful situation.

[Michael Schuch]

Here's a link to the Iowa Department of Insurance.

https://iid.iowa.gov/contact

As a private individual trying to get money out of them you really don't have any leverage. The Iowa insurance division decides if they are allowed to sell insurance in Iowa or not and can levy some hefty fines if they get enough complaints. It will only cost a little bit of your time to contact them or fill out a complaint online. That is a lot cheaper than hiring an attorney!.. AND companies like John Hancock, or whoever their parent company is, has a whole staff of lawyers that specialize in dragging cases out in court for as long as possible which will just make your attorney rich while "working for your best interests".

Please, try filing a claim with Iowa insurance regulators!
https://iid.iowa.gov/insurance-consumer-complaint

You might be shocked at how fast John Hancock reacts after getting a formal complaint from the insurance regulators!