Long Term Care Insurer Confesses To Shock Payment Stoppages

LTCi Executive Confesses To Systematic Efforts To Shut Off Claim Payments

Long term care insurance (LTCi) policyholders face so many obstacles to getting their claims approved (let alone paid in full). Unfortunately, the struggle isn't over after claim approval.

In recent years, policyholders have been flooding their state insurance regulators with a new type of complaint. Their claims were approved, they began receiving payments, and then suddenly the payments stopped.

One recent lawsuit against a major LTC insurer finally removed all doubt and validated consumer complaints. When a company executive went under oath and was forced to answer the tough questions, he had nowhere to turn and admitted that they're always looking for reasons to rationalize cutting off payments.

The subject of the questioning was whether the insurer actively attempts to contest ongoing claims after they've been approved. The "facts" the executive references include anything billed to the insurer (typically care notes, provider types, and rates even when they were previously approved).

Here's the relevant excerpt:

Attorney Question:  So the company investigates all claims for possible contestability; is that right?

Insurance Executive Answer:  We're looking at that aspect every time, for sure.

Attorney Question: So there must be some parameters in place at the company for when to conduct such an investigation, is there?

Insurance Executive Answer: No. It's open-ended. So it's really a decision based on what we think the facts of that case might be.

Investigations Are Designed To Blind-Side & Overwhelm

In other words, the executive is saying make up things that aren't true and use that story to end your claim. It doesn't matter if the story is true to them, as long as they're committed to sticking to it. It's another case of "I couldn't make this up if I tried."

When insurers excessively scrutinize billing submissions and look for a way out, it's all happening behind the scenes. A subsequent investigation into the same insurer's practices revealed that they do it entirely in secret. A policyholder never knows it's happening until payments are suddenly cut off. Even then, you're unlikely to receive an explanation that makes sense to a reasonable person.

They Leave You To Fend For Yourself

If you try to appeal the payment stoppage yourself, insurers leave you to reverse engineer their wild rationale. After you've done that, you're left all on your own to prove your position, provide evidence, and wait for a decision.

They foist the burden on you because they know that many people won't go through all the effort of an appeal. It's purely a numbers game to them. A game of thinning the pool of payments they would otherwise be required to make.

The Ill-Gotten Gains Save Insurers Hundreds Of Millions

These unethical practices produce massive rewards for insurers.  The stoppages save them hundreds of millions, if not billions every year.

We Safeguard Your On-Going Payments

Securing uninterrupted payment requires constant vigilance and discipline. Our efforts do not stop after your claim is approved. It's the biggest step, but it's not "mission accomplished."

Whether we're billing an insurer on a bi-weekly or monthly interval, we work with your provider to ensure that each bill is 100% compliant with reimbursement requirements and leaves nothing open to alternate interpretations.

Insurers are looking for low-hanging fruit and easy targets to pick off. We work hard to make sure that's not going to be you.

Are you considering filing a claim? Do you have one submitted already but it's not going anywhere? Either way, why work hard so hard to get paid less than you're entitled to?

Reach out to us today by scheduling a free consultation in real-time.  We're here for you.

Find out what you have to gain using LTCAE's professional claims management. We make insurers keep their promises and treat you with the dignity you deserve.


Author: Eric Michael Salter, JD

Leave a Comment