ComplaintsforLifeCare Assurance Company

• Initial Complaint

  08/01/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  ************************* Insurance has not replied to any of our requests for updates on a policy paid yearly since 1998. ************** was admitted to ***************************** on 1/7/2022, after a qualifying 3-night stay at ***********************************. Mrs. ******* currently resides at ************ skilled nursing facility as a long-term resident. **************'s family opened a claim with ********** January 20th, 2022. ************** exhausted her 90-day elimination period on April 6, 2022. On June 9th, a letter was sent to ********************* acknowledging receipt of documents, including Authorization for Release of Health Information, Power of Attorney documents, Claimant's Statement and Fraud Notice, Attending Physician's Statement and Fraud Notice and Care Plan and invoices from ************. On June 28th, ***************************** faxed 263 pages of documents including plan of care and Medical and Treatment Administration records. This fax was acknowledged as received by a ********** representative and Director of Admissions for *****************************, Ann Bruce. As of this date, August 1, 2022, there has been no written or verbal response from ********** and no monetary reimbursements made to Carl *******. The family of ******* ******* asks that ********** respond to clarify where this claim stands. Respectfully, ********************************************************************************* We have called, emailed and faxed but have received no response from **********. Our contacts there are ************** (Adjuster) and *********** (management)

  Business response

  09/02/2022

  Business Response /* (1000, 5, 2022/08/03) */ Mr. *******, We are sorry to hear that our response time is not to your satisfaction. The claim review process can be affected by a number variables that needs to be carefully adjudicated and deliberated on. According to our records, a manager did reach out ************************************* on August 2nd to give you an update on the status of the review. The manager advised ************* that the review would entail an extensive document review and, that the review will be completed within 2 weeks at the latest. Consumer Response /* (3000, 7, 2022/08/07) */ (The consumer indicated he/she DID NOT accept the response from the business.) We have been in contact with ******************** Ins. company since JANUARY of 2022. It took the representative for ********** almost seven months to give us (the family) the explanation that the claims adjuster did not have all the information / paperwork needed. In every email and conversation I requested in writing that ********** specify the documents they needed to work this claim. I contacted ******* in January, again in February, several times in April, almost weekly in May and in June. We have been told that the claim adjuster should have a "verdict" by Friday August 12th. We still believe that ******* has been dragging their heels in response to the claim. I will withdraw the complaint when/ if we hear back from the adjuster when he said he would contact us. Business Response /* (4000, 9, 2022/08/10) */ We would like to apologize for the delays in the claim process, however we disagree that we are responsible for these delays. On 6/9/22 we sent you a status update letter acknowledging receipt of preliminary claim forms and provider documentation. That letter also stated that we sent an additional request to your wife's provider for information and completion of Long Term Care documents. Following our receipt of the documentation we confirmed eligibility in a phone call with daughter on 8/2 and sent a letter confirming the same on 8/4. On 8/10 our adjuster reached out to you to confirm this information.

• Initial Complaint

  04/07/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My parents purchased a long-term care insurance policy from John Alden Long Term Care in the mid 90s. Now my parents have need of the policy and we cannot get any resolution from the company. We have been trying for over a year. The company loses paperwork we send, shuffles us around to different claims reps, tells us a decision is pending, only to ignore us for months. Meanwhile our parents resources dwindle as they self-pay for long-term care. We are prepared to take legal action as well as taking this to the national media. Our first step, however, is to open a claim with you since this seems to be a common problem. We have extensive notes, records and paper trails, documenting everything we have done to expedite this process. Would be happy to share all the details in order to get a resolution. They did finally tell my sister and I that our mother was deemed "eligible" under their plan (she has Alzheimer's) but they have never taken any action, approved reimbursement or begun paying for the care services.

  Business response

  07/06/2022

  Business Response /* (4000, 14, 2022/06/09) */ **. *****, ********** and LifeCare are very sympathetic to both your parents' medical conditions, and the stress that this may have caused you and your sister. However, we disagree that we have lost paperwork and ignored your parent's claim for months. Both ********** and LifeCare strive to provide excellent customer service to insureds which requires a complete, careful and thoughtful analysis of every claim. Your Father's Claim Your father's claim was denied due to the determination that he did not meet the eligibility requirements under the provisions of your policy. In order to be eligible for benefits you need to require assistance with two ADLs (Activities of Daily Living) or have a cognitive impairment that requires continual supervision. Based on the information we have received your father did not meet these standards, which were communicated in a letter in December 2021. Your Mother's Claim Yes, we did approve eligibility on your mother's claim in September 2021, but the initial provider was not approved as it did not meet the terms and conditions of the Policy as we advised in advance of her eligibility determination in July 2021. The current provider documents requests were ignored two times which has delayed the adjudication process and currently facility approval is under review. However, we do need to recertify your mother's medical eligibility because a year has gone by since the claim has been opened. We have requested a Nurse Care Manager evaluation for your mother, but have not yet set up an appointment. We will continue to work with you and your family, and to review any new information or documentation that is provided to us to adjudicate your parents' claims. We trust the foregoing resolves this complaint and this matter can be closed. Consumer Response /* (4200, 16, 2022/06/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) I hesitate to accuse them of lying; perhaps they are just woefully inept. This has been ongoing for almost two years and we have kept meticulous notes and documentation. We have overseen the delivery and completion of necessary paperwork on our end, only to be told they did not receive it on their end. Our emails and phone calls routinely go unanswered and a case in point is the re-evaluation of my mother, which was conducted weeks ago (although they claim in their BBB response that they are still trying to set it up.) I spoke directly to the practitioner engaged by **********/Life Care Assurance to do the evaluation and she was shocked that they had not yet followed up with the family regarding her findings -- this was a couple weeks ago and we STILL have not heard back from them. Indeed, I emailed last week asking for a status update and have heard nothing. My mother AND the facility have met and continue to meet, at a minimum, the standard for home health care support as defined in the contract, but they refuse to acknowledge or reimburse for that, let alone to approve and begin paying for the long-term care aspect of the policy. As a media professional, I understand the impact of national publicity and I can assure you, we will not be fading quietly into the woodwork. I am horrified by this treatment and I suspect that most folks simply give up or the beneficiary of the plan dies in the interim. We are preparing a national response and I hope the Better Business Bureau acknowledges that no one should have to wait 18 months and be ignored, disregarded and refused information. I am grateful my sister keeps such meticulous records because creating a paper trail in this case will be quite simple. I am done waiting for **********'s response; next week we begin the process of fighting back. Business Response /* (4000, 19, 2022/06/17) */ **. *****, As of today, our adjuster contacted our vendor to confirm the status of the Nurse Care Manager Assessment. The assessment was placed on hold because 5 calls were placed and none of them were returned. We also made a call to you to advise you that we did not receive the assessment, but you did not answer and we left a voice mail. It is imperative that your mother complete this assessment to satisfy recertification process. Please contact the adjuster as soon as possible. Business Response /* (-10, 21, 2022/06/24) */ As of today, our adjuster contacted our vendor to confirm the status of the Nurse Care Manager Assessment. The assessment was placed on hold because 5 calls were placed and none of them were returned. We also made a call to you to advise you that we did not receive the assessment, but you did not answer and we left a voice mail. It is imperative that your mother complete this assessment to satisfy recertification process. Please contact the adjuster as soon as possible at **********************

• Initial Complaint

  03/30/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  We purchased a Long Term Care policy from **** ***** win June 1995. We have been paying ther premiums since then. The wife developed early dementia about 5 years ago and was placed under a local neurologist. Her condition deteriorated over time. About a year ago, she started hallucinating about people being in our backyard doing nefarious things. I thought it was her imagination. In early July 2021, she wandered off on a very stormy afternoon. About 9PM the doorbell rang and there was a gentleman who had seen her out walking in the storm so he brought her home. I notified the neurologist and he said to take her in to the ER as she was a danger to herself. I replied, being the 4th of July weekend that I would do it on Tuesday after the holiday weekend. He said I should take her then. I didn't. The next morning, she disappeared and I got a call from a local facility that she was there and was confused. I brought her home. About a half hour later, I noticed she was gone again. I drove down the street and saw walking. I picked her up and took her to ER. ************************************************************************************************************************************************** She was examined and put in the hospital. She has been at three medical facilities for dementia during July and finally was placed in a memory care center. In August 2021, I filed a claim with **** ***** **** They asked for various things most of which were provided. Then they asked for the medical records. They procrastinated in their request but after follow-up finally filed the written request. I was led to believe that that was the final step. But NO, they then asked for test results. They have been giving me the runaround for bout 8 months will still no determination. Meanwhile, I have been using our savings to pay the *** monthly charge at memory care. I finally invoked intervention by our State Insurance Commissioner but so far ***** hasn't finalized the claim.

  Business response

  06/10/2022

  Business Response /* (1000, 16, 2022/06/10) */ **. ******, **** ***** gives our condolences on the passing of your wife and are very sympathetic to the added stress this process may have caused you during this difficult time. We strive to provide excellent customer service to *****'s Insureds and the current adjuster assigned to your wife's claim has been in regular communication, either by mail, e-mail, or telephone conversations. Initially, the adjuster advised you of the need for medical records. Unfortunately, there was confusion in the documents you originally submitted. You provided a Power of Attorney (POA) early in the claim, but it did not authorize release of health information. Pursuant to the adjuster's several requests, you provided a medical POA on in February 2022, and the records were requested three days later. The adjuster spoke with you on in early March to confirm the records had been requested. During the month of April we confirmed that your wife did meet the eligibility requirements under the policy and later confirmed your wife's provider was approved. The requests for residency confirmation and billing invoices in the month of May are necessary to determined what benefits that are owed. This request is not due to a lack of communication, but a normal part of the adjudication process. We will continue to work with you and your wife's provider to review any new information or documentation that is provided to us to adjudicate her claim. Consumer Response /* (3000, 18, 2022/06/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) As noted, she died on 20 April. ***** has a copy of her death certifiocate. Whay in **** are they "The requests for residency confirmation and billing invoices in the month of May " She is in Heaven with our Lord and could not have been in residence here on earth in May! Business Response /* (4000, 22, 2022/06/17) */ **. ******, **** ***** understands that your wife has passed and we know this is a very difficult time. We are sorry for the confusion, the requests for documentation and invoices were sent in the month of May but were meant for April. ***** only wants the documentation that will help determine what benefit payments are owed to you. We will continue to work with your wife's providers to get the necessary documentation to adjudicate this claim. Consumer Response /* (4200, 24, 2022/06/22) */ (The consumer indicated he/she DID NOT accept the response from the business.) This seems like another of the procrastinations that I have received from them over the last several months. When I see closure by payment then I will accept their comments. Business Response /* (4000, 28, 2022/07/01) */ **. ******, We are in contact with your wife's provider, we have received the last remaining invoices. We emailed a facility representative the residency confirmation letter she needs to complete and return to us. Our claim adjuster has called the facility representative a couple of times to tell her that the residency letters were blank. As soon this form is returned to us completed, **** ***** can pay your wife's benefits. Business Response /* (1000, 16, 2022/06/10) */ **. ******, **** ***** gives our condolences on the passing of your wife and are very sympathetic to the added stress this process may have caused you during this difficult time. We strive to provide excellent customer service to *****'s Insureds and the current adjuster assigned to your wife's claim has been in regular communication, either by mail, e-mail, or telephone conversations. Initially, the adjuster advised you of the need for medical records. Unfortunately, there was confusion in the documents you originally submitted. You provided a Power of Attorney (POA) early in the claim, but it did not authorize release of health information. Pursuant to the adjuster's several requests, you provided a medical POA on in February 2022, and the records were requested three days later. The adjuster spoke with you on in early March to confirm the records had been requested. During the month of April we confirmed that your wife did meet the eligibility requirements under the policy and later confirmed your wife's provider was approved. The requests for residency confirmation and billing invoices in the month of May are necessary to determined what benefits that are owed. This request is not due to a lack of communication, but a normal part of the adjudication process. We will continue to work with you and your wife's provider to review any new information or documentation that is provided to us to adjudicate her claim. Consumer Response /* (3000, 18, 2022/06/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) As noted, she died on 20 April. ***** has a copy of her death certifiocate. Whay in **** are they "The requests for residency confirmation and billing invoices in the month of May " She is in Heaven with our Lord and could not have been in residence here on earth in May! Business Response /* (4000, 22, 2022/06/17) */ **. ******, **** ***** understands that your wife has passed and we know this is a very difficult time. We are sorry for the confusion, the requests for documentation and invoices were sent in the month of May but were meant for April. ***** only wants the documentation that will help determine what benefit payments are owed to you. We will continue to work with your wife's providers to get the necessary documentation to adjudicate this claim. Consumer Response /* (4200, 24, 2022/06/22) */ (The consumer indicated he/she DID NOT accept the response from the business.) This seems like another of the procrastinations that I have received from them over the last several months. When I see closure by payment then I will accept their comments. Business Response /* (4000, 28, 2022/07/01) */ **. ******, We are in contact with your wife's provider, we have received the last remaining invoices. We emailed a facility representative the residency confirmation letter she needs to complete and return to us. Our claim adjuster has called the facility representative a couple of times to tell her that the residency letters were blank. As soon this form is returned to us completed, **** ***** can pay your wife's benefits. Consumer Response /* (2000, 36, 2022/07/30) */ Received settlement. It was a trying affair but all wrked out in the end.

• Initial Complaint

  01/13/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  Have been attempting to obtain Long-Term-Care (LTC) claim payouts (two claim policies) on behalf of my mother, who is now in the nursing home. This process started back in August of 2021 and claim numbers were finally issued on 9/1/2021. Of course additional information was required and I promptly addressed each request for each new set of required information. The primary problem is extreme lack of follow-up on John Alden's part. I have a complete listing of all of my calls and emails, requesting status and/or a follow-up callbacks...(more than 10 occurrences). I even went as far as to file a formal complaint (via email) to their customer service department (11/16/2021), but never received a reply. I have called and left messages with our claims adjustor (**************) and have never received a call-back from him; however I was able to talk directly with him one time (11/19/2021), probably because I went through the main number and told them that I was not willing to leave a message and asked to speak to his supervisor. During this conversation, he told me that he had tried to call me, but a quick check of my phone records, showed no such call was ever received. He also said that additional information was required (needing my Medical POA in addition to my Durable POA, which they had on file as of May of 2021). It is more than apparent to me that they are employing every kind of delay tactic that they can think of and are not the least bit willing to provide even the most basic of customer service. This is inexcusable in my mind, since my parents have been faithfully paying on these policies since 1995 & 1997 respectively. I will leave you with the two claim numbers that I am trying to have activated and begin receiving payments on my mother's behalf. Claimant: *****************; Claim Numbers: ******** & ********. I appreciate any assistance you can give us. Best Regards, ********************

  Business response

  04/22/2022

  Business Response /* (1000, 16, 2022/04/22) */ **. ******, We acknowledge there were delays in the adjudication process, but we respectfully disagree that John Alden and LifeCare are responsible for the delays in adjudicating the claim. According to our records many of the delays are attributed to the a lack of medical of records and provider documentation. However, after we received the proper documentation, we issued payments under the policy within 14 days. We are happy to report that we have issued the initial payments for the claims under each of your policies. Consumer Response /* (2000, 18, 2022/04/28) */ (The consumer indicated he/she ACCEPTED the response from the business.) ********** eventually did begin the payout process.

• Initial Complaint

  09/24/2021

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Long Term Care Policy #*********. Premiums were paid annually from 1997 to 1/11/20 when mom qualified to use her LTC benefits for memory care. Last payment from ltc received 03/15/21. Mom passed away on 4/17/21. Received a letter saying they needed trust documents and confirmation of residency before they would reimburseme for the last 48 days of care. The memory care states they sent docs mulitple times. I faxed trust docs once and also sent a total of 19 emails with docs. Ltc says they did not receive. Research revealed that 17 of those emails "failed permanently". All messages were sent to same email address. The last 3 voice messages I left with adjustor, ***** ******, on 8/10, 8/18, 8/20 have not been returned. I spoke with claims manager, *** ******* on 8/20/2021. She said I would receive money the following week. As a precaution, I sent all docs via USPS to attn of *** ******* on 8/24/21. It has been 5 weeks and I have not been reimbursed.

  Business response

  12/14/2021

  Business Response /* (1000, 14, 2021/12/14) */ We just received the letter a couple of days ago, so this was our first notice. Our condolences on the passing on your mother. We apologize for any delays or frustration that this process has caused. John Alden has received and reviewed the estate documents and residency information, and approved your final payment of $********* on 10/4/2021. Please let us know if you have any further questions.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩