The LTCi industry’s top tool in their fight against policyholders

The LTCi industry’s top tool in their fight against policyholders

I’m a big supporter of nurses. My family is made up of two nurse practitioners and two RNs. I’ve spent my entire legal career supporting and protecting healthcare professionals.

I have a problem with how the LTCi industry misuses nurses to physically and financially harm policyholders, as well as hurt caregivers’ ability to earn an honest living. Nursing is a helping profession and insurers capitalize on that image to mislead families into believing they’re acting in your best interest.

I’m not talking about nurses who physically care for people. I’m talking about corporate nurses hired by the insurance companies to work against families, all to save a buck for the company. Insurers call them “independent assessors” and “care coordinators” (no one who is paid by a company is independent).

I simply call them Insurance Company Nurses, or “ICN’s.”

ICN’s are evaluated and rewarded based on how much money they save the insurance company. There’s only one way they can do that: by minimizing your needs or seeking to disqualify you from coverage.

Enter the twilight zone of the LTCi industry

The use of ICN’s is the industry’s primary tool for cheating on their promises to policyholders and for underpaying caregivers.

LTC insurers won’t tell you that if you talk to their ICN’s and allow them to “help” with your claim, you’re signing away your right to make your own health decisions and you’re also allowing them to set your caregivers’ pay rates.

If you get sick, you go to the hospital and bring your health insurance card. If you injure your knee, you go to your doctor’s office and do the same. Could you imagine a system where you’re led to believe that you must first call your insurance company and have one of their hired hands pay you a visit?

If your health insurance company had ICN’s, would they tell you to get some rest or would they recommend that you go to the hospital to see if you need treatment? Would they have you get x-rays or an MRI of your knee and then visit an orthopedic specialist? Or would they recommend that you put some ice on it and take it easy?

Even worse, if your health insurance worked anything like LTCi, by merely seeing the ICN, you’d be waiving your right to go to the hospital or to get approved for knee surgery. You’d have to file an appeal, which would be pointless in those moments.

LTC insurers get away with their system because, unlike health insurance, LTCi is not federally regulated. Their alternate universe has no equivalent in the health insurance world. If health insurers acted that way, they may be committing a felony.

Fortunately, LTC insurers still have to abide by contract law and you don’t have to listen to what they tell you. You have legal protections in your insurance policy that protect your right to make your own decisions. The insurance companies wrote the contracts themselves, but you must assert yourself to hold them accountable.

“Just enough care. Not too much”

When one of the companies first started pushing care coordination 10 years ago, they sent employees information on how it all works. One of those documents is still circling online.

That document says that the role of care coordinators is to make sure policyholders get “Just enough care. Not too much.”

Enough means only enough to avoid wrongful death lawsuits.

Not too much means under-qualified caregivers and fewer hours of care.

Cost-cutting basics

Around that same time, the head of the care coordination division at that same company sat down for an interview with an industry publication. That interview belongs in the “truth is sometimes stranger than fiction” files.

Among other cost-cutting tactics, he stated that the first thing they do is look at the care you need and deduct 1/3 from there.

That means either cutting care hours by 1/3 or cutting reimbursement to providers by 1/3 (the result is effectively the same). Policyholders are then told to “take it or leave it.”

That’s “not too much. Just enough” in action

A confidence game

The worst part of all is how good they are at making families feel like they don’t have a choice. They’ve honed their deception over millions of claims. They rely on the psychology of “authority bias.” They’re the big company, so they assume policyholders will follow any cues they give out.

In fact, Genworth hides your options completely. If you go to their website and read about the claims process, the steps for getting your claim approved are as follows:

  • An independent assessor (an ICN) will visit you for an in-person assessment; and
  • That information will be given to a Privileged Care Coordinator (another ICN) who will develop your personalized plan of care.

The term “Privileged Care Coordinator” is trick wording that any good lawyer can spot. It isn’t you who is receiving a privilege. You are giving them the legal privilege to make your care decisions.

You have strong legal protections

There’s one thing missing from Genworth and all of the other insurers’ websites. It’s something they won’t tell you on the phone, either:

The words in your contract are the only ones that matter.

As I write this, I’m looking two of Genworth’s popular policies. They are single-spaced, 43 pages long, and written in 10-point font. Buried on page 20 is the following passage:

You are not required to use these Privileged Care Coordination Services. You may, at Your own expense, use a Licensed Health Care Practitioner who is not from a Privileged Care Coordination Team to provide a Plan of Care, Current Eligibility Certification, or assist in coordinating services.

In other words, you have the legal right to use your own professionals and make your own decisions. That’s ironclad protection.

Seize control of your health decisions

At LTCAE, we created a system that resembles the health insurance process you’re already familiar with. You get to choose your own providers and you get to make your own decisions.

Perhaps the best part? You never have to pick up the phone and talk to anyone at the insurance company.

We analyze the fine print and legalese in your contract when we pre-qualify your coverage. After that, both you and your provider get a comprehensive, step-by-step guide for matching services to what your policy will pay for.

Our nurses speak the language of providers, save them time, and streamline the process for everyone. You get treated with the compassion and respect you deserve, your providers can give you the care you need, and you’ll also know that they’re paid fairly.

Quite the opposite of ICN’s, the better you get paid, the better you do. Your success is our success.

Reach out to us today for a free consultation and give yourself the gift of peace of mind.


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