Okay, so it’s not exactly a scam… except…
Read on.
Last year an elderly gentleman’s wife was dying. For decades they had paid into a long term care policy, and had amassed nearly three quarters of a million dollars available to be paid out for non-medical support with ADLs (activities of daily living such as bathing, dressing, toileting, incontinence care, feeding, etc) and homemaker services (housekeeping, laundry, meal prep, etc), if the wife ever became disabled.
Two years earlier the wife had indeed become disabled. While she required some nursing care, they mostly needed the kinds of non-medical supports listed above. Her husband was in his 80s and just could not do everything that needed to be done to help support her.
They worked with an agency that was registered with the State of Maine’s Department of Health & Human Services to provide those supports. The requirement by insurance companies is that the policy holder pays the cost of the providers first, then gets reimbursed by the insurance. The agency apparently kept telling the clients that they would get reimbursed, but they never did.
There’s a similar situation going on right now with one of my clients. My business is registered with DHHS as a Personal Care Agency but I can’t seem to get anywhere with the insurance company. They keep insisting I have to provide a LICENSE number, but DHHS does not license Personal Care Agencies because we are non-medical. DHHS only licenses agencies or individuals when they provide a medical service.
In the meantime, my client is paying thousands of dollars to my business (for my services) for which she isn’t getting reimbursed, despite having a LTC policy that covers exactly the services I provide. And I have been on the phone with that insurance company constantly regarding this.
I have already encouraged my client’s family to file a complaint with the Maine Bureau of Insurance. (The Bureau of Insurance won’t take a complaint from a provider such as myself, or from someone acting for a provider, which was the case when I was doing back office operations for therapists. I learned that when Anthem was in hot water with the State of Maine and DHHS.)
Great fun all around. (Yeah, not so much.) It irks me something fierce that people buy these policies and then can’t use them when they’re needed. And although I understand that we are living longer and the long term care needs of many policy holders are far more than the actuaries ever expected, it really doesn’t matter. That’s the risk insurances take when they write policies… and generally, the insurer comes out waaaaay on top.
They need to “man up” and pay what they owe.
Categories: Insurance, Long Term Care Insurance
Heritage Homecare Services 
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