Long Term Care and Dementia

[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.

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!