I filed a claim on August 30 prior to her release after 3 weeks in a skilled Nursing center. So far Hancock has slow walked the claim. When I call them after they have received the requested medical information I’m told they have 13 more days to determine her eligibility. Then the qualification period kicks in. Any suggestions on how to speed up the process. I’ve threatened contacting the insurance commissioner.
I would also contact local press (consumer advocate in local print and broadcast press), local elected officials (the all have elder affairs specialists) and ask for them to advocate on your behalf with JH.
Complaining to insurance commissioner before qualifying period is done is, imho, a waste of energy as it’s not in payout phase yet as per policy terms. The policy not activated yet. We went thru Katrina & Deepwater Horizon claims & imo insurance commissioner really can’t do much for individual situations other than write you a letter of we’ll look into it. It’s got to be a huge # of policyholders that are filing to get any traction. & even then the paperwork is daunting.
You might want to think of the qualifying as a deductible that has to be paid BEFORE the policy will activate. It will be a hefty deductible as it means private paying for basically 3 months in a NH as that’s the qualifying period if it’s that type of LTC policy or 3 months of home health if it’s that type. And the count down usually starts day 1 from when they are no longer hospitalized & no longer considered a rehab patient in the facility, as those periods are covered in some way by Medicare and other insurance (usually LTC insurance wont pay if another insurance will).. So if she transition from being a rehab patient to a NH LTC resident on Sept 1 then her first day LTC policy activation Nov 29. If you applied “prior to her release” before she transitioned, it’s going to be denied from the get go as she’s was not in a LTC yet and it can’t be an active file. Which is going to make things even more confusing all around. Most LTC have a preauthorization schedule for filing, like 15 days before she hits her 90 day mark, is when you can file. And then they send the paperwork that the facility has to do IF it’s that coverage or to home health agency IF it’s that coverage. You can’t speed up the process, it’s whatever’s in the terms of the policy that is the playbook.
Do you know what the DBA (daily benefit amount) is for her policy? How much of a “gap” or shortfall to cover her daily rate? Do you have an inflation rider or index on the policy? Sometimes families find that having them go onto LTC NH Medicaid is better financially. If that could be a possibility, please get with a NAELA or CELA level of elder law attorney as the situation for NH spouse & community spouse is not simple.