Business ProfileforLifeCare Assurance Company

My mother has had her LTC policy with John Alden for 20-25 years, paying ever-increasing premiums, every month. In recent years, she has filed several, periodic claims for in-home assistance care. Every time, it's a major ordeal getting John Alden to reimburse her. It's always one excuse and delay, after another. You complete the forms they send. Then, you confirm they have everything they need from you. You call a few weeks later to find out why they haven't issued payment, and they tell you there's a problem with one of the forms you completed. Every time you think you've resolved all the obstacles, they tell you there's another one. With every claim, they say they need copies of the same medical records, documenting the same medical disabilities, again. Then, when you submit another claim for reimbursement, the same, maddening process starts all over again. This is why people hate insurance companies, in general.

We're sorry to hear that you are dissatisfied with the claim adjudication process, however, the requirements of the policy are clearly stated. Every Long Term Care policy outlines the requirements for submitting preliminary claim forms, establishing medical eligibility, and qualifying for benefit paymentsand each aspect of this process requires documentation to be submitted. Upon receipt of this documentation our team will review and advise promptly if there are any issues with the documentation or if anything further is needed. For example, we may require power of attorney documents and/or a HIPAA Authorization form in order to obtain medical records from an insured's providers. Without the documents that provide us with authority to receive medical information, we cannot adjudicate a claim.

For claims paid over time documentation will be required on an ongoing basis to confirm that an insured remains medically eligible and that covered care is being provided. Care records are necessary to determine the proper amount of benefit payments. It is not possible for us to properly adjudicate benefits according to the terms of the policy without significant documentation. When documents necessary to adjudicate a claim are not provided, after multiple requests, we may close a claim prior to a decision being made regarding medical eligibility. Should an insured decide at a later time to pursue a new claim we are still required to collect all of the documentation described above including updated medical records and current evaluations of the insured and any medical conditions they may have.

We are always available to answer questions about the claim process, eligibility, or any other aspect of the policy.

Thanks,
Bryan

Derek Lane
Director of Litigation & DOI Complaints
(818) 867-2496
**********@LifeCareAssurance.com