John Hancock not there when you need them.

Jul 10, 2019

  1. marianne2911
    Offline

    marianne2911 New Member

    Posts:
    4
    Likes Received:
    0
    State:
    Florida
    my husband had an unexpected stroke due to a malpractice mishap at a hospital who has immunity.
    The stroke was catastrophic, he has no cognitive ability, is bed bound, has breathing issues and his whole left side is damaged. I tried to call them on Monday, all you get is a recorded message that says don't call on Monday or Tuesday cause we are busy. I have called numerous times, tried register online, etc to no avail.
    I finally after days of trying got some girl in India? who knows, that told me she couldn't help me because I wasn't him, I retorted that I was sick of this, this was nothing but a scam and that I was going to the Attorney general and Insurance commissioner. She finally relented and is going to send me the claim forms and sent me a statement of coverage. I left a call back message 3 hours ago and they just called back. again fromIndia, Pakistan or other third world location, who knows. I am glad we have the coverage but I am really scared that this is nothing but a device to collect funds and pay nothing out. I have a form filled out for the state insurance commissioner at the ready.
     
  2. fed up
    Offline

    fed up Guru

    Posts:
    413
    Likes Received:
    230
    State:
    Virginia
    Who did you purchase your ltc policy from? Call your agent, hr department, or place where you purchased the policy.
    Call these numbers 800-377-7311 - or - 800-233-1449. Needing information when you have been at a hospital all day is stressful enough but you need to call during business hours and should not be getting the run-around.
    If your husband is covered under medicare make sure you know your rights under Medicare. The hospital will try to move him out quickly and you can ask for a Medicare review which gets you a few more days in the hospital so you can visit rehab facilities or ltc facilities before he is moved
     
    fed up, Jul 11, 2019 at 8:35 AM
    #2
  3. marianne2911
    Offline

    marianne2911 New Member

    Posts:
    4
    Likes Received:
    0
    State:
    Florida
    thanks re info re medicare. He is currently in sub acute rehab facility now. I want him to stay as long as possible and I dont know how to do that if possible. He has medicare part a and b and well as he kept his regular insurance from when he was working for the usps.
    I have no idea who sold him the policy , he is not cognizant to tell me. I called during regular business hours. Now they dont want to help me because of HIPPA. I guess I have to pay a lawyer to make them move. I dont know what else to do. this is a mess. this all happened unexpectedly due to a medical mishap and the hospital has immunity.
     
  4. fed up
    Offline

    fed up Guru

    Posts:
    413
    Likes Received:
    230
    State:
    Virginia
    First 90 days are covered under medicare so you have some time to collect your thoughts and get some answers. Lane Insurance is listed as a Hancock agent in Florida, 239-947-7474. Start there and see what advice they can give or are willing to help with
     
    fed up, Jul 11, 2019 at 11:57 AM
    #4
  5. somarco
    Offline

    somarco GA Medicare Expert

    Posts:
    29,544
    Likes Received:
    3,404
    State:
    Georgia
    This is posted in the LTC forum.

    Is the OP's beef over a Hancock LTC policy? Pretty sure those guys are not in the traditional or Medicare health insurance biz.

    OP does mention Medicare A & B + USPS coverage "when he was working". Is he covered as an active employee or retired?

    Also curious about the "hospital immunity" comment

    Lot's of questions here.
     
    somarco, Jul 11, 2019 at 12:17 PM
    #5
  6. marianne2911
    Offline

    marianne2911 New Member

    Posts:
    4
    Likes Received:
    0
    State:
    Florida
    He has part A and B medicare &insurance from NALC/Cigna on a retired basis. High Option. I think its the same as when you are working? Plus hancock LTC. In 2011 Florida passed a malpractice immunity law that says in condensed form that any teaching hospital has complete immunity and responsibility from any malpractice litigation. See Bean v. University of Miami. Latoya bean lost her baby, Noah, due to the hospital not doing the c section when the little guy was in trouble and consequently died, Also Fernando Varicello lost his eyesight due to a mishap. this went to the 3rd court of appeals that ruled last August 2018 that the hospital had immunity and both cases were dismissed.
    buyer beware.
     
  7. somarco
    Offline

    somarco GA Medicare Expert

    Posts:
    29,544
    Likes Received:
    3,404
    State:
    Georgia
    Still having trouble following the pattern of your questions.

    "Malpractice" does not disqualify the claim. It only means a lawsuit attempting to collect damages because of alleged malpractice probably won't go far.

    It would appear your husband has a retiree plan that is specific to the USPS/NALC union. The Cigna plan seems to be a form of Advantage plan where your benefits are determined by Cigna. The plan is a PPO managed care plan.

    You are pretty much at the mercy of the carrier/TPA although there is almost certainly an appeal process.

    The plan is most likely self funded. As such neither the AG or DOI have jurisdiction over the plan including admin and claims.

    The Plan offers a comprehensive High Option health benefit package, a fee-for-service plan with a preferred provider (PPO) network

    NALC Health Benefit Plan is best fit for letter carriers and their families

    However this line on the referenced page seems to indicate there are situations where original Medicare is the primary payer.

    If Medicare is your primary payor, the High Option Plan also offers great benefits.

    Original Medicare has no networks.

    Essentially it is difficult to figure out what your husband has. A retiree "Advantage" plan or traditional Medicare with a supplement plan . . . that also has networks.

    A real mystery.

    The plan falls under the jurisdiction of OPM. Perhaps they can offer some guidance.

    Just found this page which provides a little more insight into plan choices.
    Medicare Benefits

    This (above) seems to indicate you have a choice of original Medicare with NALC acting as a supplement plan

    or

    the NALC can have an Advantage plan option.
     
    somarco, Jul 11, 2019 at 4:15 PM
    #7
  8. Chazm
    Offline

    Chazm Guru

    Posts:
    5,002
    Likes Received:
    1,105
    State:
    Florida
    Is she trying to put her husband in a long term care facility right now, have hospital claims paid, or looking for info on malpractice?

    I’m lost.
     
    Chazm, Jul 11, 2019 at 5:21 PM
    #8
  9. somarco
    Offline

    somarco GA Medicare Expert

    Posts:
    29,544
    Likes Received:
    3,404
    State:
    Georgia
    It is a bit confusing.

    In a situation like this there is a lot of stress. Trying to understand insurance, especially several different kinds spread over multiple carriers, only compounds the issue.
     
    somarco, Jul 11, 2019 at 6:53 PM
    #9
  10. marianne2911
    Offline

    marianne2911 New Member

    Posts:
    4
    Likes Received:
    0
    State:
    Florida
    Medicare is the first payor and the NALC high option is secondary. I am not concerned about the hospital bills being paid (maybe I should be) but my main goal is to keep in the the Sub Acute Rehab hospital as long as possible.As I understand medicare only pay for two weeks. I dont want him home, I want him to get the best rehab possible. They want to send him home with 24 hour care in two weeks.
    Second goal would be to file a malpractice which I understand after speaking with two lawyers, one of which is also physician, is an impossibility due to immunity ruling last August. 3rd goal is to get John Hancock to recognize he has a policy and stop avoiding me and pay claims. Those are my goals. This was a totally unexpected event that has many parts to it including a business. . I was totally unprepared as I let him be the chief cook and bottle washer so to speak. I admit I am totally lost. thanks ever for all your input. You have no idea how much is appreciated.
     
Loading...