Kemper Home Health Care Claim Question

Rearden

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Hello,

I have a client who bought a Kemper HHC policy a year ago on her mother, and filed a claim recently to provide home health care.

Her agent, his boss, and his boss's boss assured her that the policy would pay her directly and give her control as to who she wanted in her home doing home health care services.

However, when her mother fell ill and required home health care, Kemper said the policy dictates to which Home Health Care agency they choose to provide the home health care.

She's obviously very frustrated and believes she's been had.

If I could provide any clarification that would be an added bonus -- anybody have any idea how these policies are supposed to handle claims to pay for home health care?


Thanks,
Dave
 
Hello,

I have a client who bought a Kemper HHC policy a year ago on her mother, and filed a claim recently to provide home health care.

Her agent, his boss, and his boss's boss assured her that the policy would pay her directly and give her control as to who she wanted in her home doing home health care services.

However, when her mother fell ill and required home health care, Kemper said the policy dictates to which Home Health Care agency they choose to provide the home health care.

She's obviously very frustrated and believes she's been had.

If I could provide any clarification that would be an added bonus -- anybody have any idea how these policies are supposed to handle claims to pay for home health care?


Thanks,
Dave

The policy does not dictate what agency but it must be a licensed service and the billing must be submitted for the claim. Subject to the individual services max per day up to the max total of $150 per day.

The check is sent to the client if desired.

Give me a call today and I will be able to assist you further.
 
Kemper's HHC plan is an indemnity plan, so they would have no say over who provides the care, as long as they are certified to do so. If the claim meets the standards in the policy, they (Kemper) should issue a check to the beneficiary of the policy.

There are thousands of home health care agencies in America, and many are local or regional, and also may be owned by particular hospital or doctor networks. There is no way Kemper could dictate which home health provider to use.
 
Kemper's HHC plan is an indemnity plan, so they would have no say over who provides the care, as long as they are certified to do so. If the claim meets the standards in the policy, they (Kemper) should issue a check to the beneficiary of the policy.

Not exactly......

The Kemper HHC plan is a Hybrid Indemnity policy, meaning it's claims are subject to a Reimbursement policy of services.

Unlike true indemnity plans that pay a beneficiary based on diagnosis. The Kemper has max limits on type of care given by a LICENSED facility, services or staffers of a facility. The policy has a cap per day on services used and subject to a daily cap and are only reimbursed based on the services used, much like a reimbursement plan. The indemnity part of the plan is that it will double pay the covered service if paid by Medical insurance or Medicare.

A True indemnity plan looks to the diagnosis and sends a check regardless of the services used to the beneficiary. This is not the case with Kemper HHC.

Thus, it is only indemnity in name (sending check to client regardless of other claims) and still follows a reimbursement policy on claims.

Now, the peanut gallery is really confused.....LOL Welcome to Medical Claims...
 
The policy does not dictate what agency but it must be a licensed service and the billing must be submitted for the claim. Subject to the individual services max per day up to the max total of $150 per day.

The check is sent to the client if desired.

Give me a call today and I will be able to assist you further.

Thanks Patrick, I will call you later, as this is a tremendous opportunity to help solidify my position with this client.
 
I get that it is subject to more than just a diagnosis, and that was a very good explanation you provided. I was over simplifying my answer to illustrate that Kemper does not pick the actual company used to provide the services, as long as they are certified to bill for services.
 
Kemper is still a company (and I have been on here touting their HHC policy) that is in disarray.

They over bill people on accident, pay out wrong commissions and then chargeback the wrong amounts..tell people things about their benefits that are incorrect.

I had a client who bought this policy last year and lost a leg a few months ago from diabetes and needs a home health care aide for a day a week and Kemper told her it didn't cover HHCA services so she cancelled. I then called Kemper and talked to claims supervisor with her on the phone and they told her it was covered. So, she reinstated it. We filed the claim and they denied it because they said they don't cover HHCA. Lol. Clearly, in the brochure (much less in the actual policy itself) it says it covers (I think 50 visits) per benefit period.

I encouraged her to file a complaint with the DOI. She did.

I will not write their product until they get their stuff in order.
 
Kemper is still a company (and I have been on here touting their HHC policy) that is in disarray.

They over bill people on accident, pay out wrong commissions and then chargeback the wrong amounts..tell people things about their benefits that are incorrect.

I had a client who bought this policy last year and lost a leg a few months ago from diabetes and needs a home health care aide for a day a week and Kemper told her it didn't cover HHCA services so she cancelled. I then called Kemper and talked to claims supervisor with her on the phone and they told her it was covered. So, she reinstated it. We filed the claim and they denied it because they said they don't cover HHCA. Lol. Clearly, in the brochure (much less in the actual policy itself) it says it covers (I think 50 visits) per benefit period.

I encouraged her to file a complaint with the DOI. She did.

I will not write their product until they get their stuff in order.

Not knowing the specific details in your Case... HHCA Services alone does not mean they are covered by the Kemper HHC policy.

They must be a licensed/certified provider of HHCA Services. Not all companies are licensed or their employees are licensed thus the services would not be covered. Plus there is a daily max of $40/day up to 60 days (except for TX-Different Schedule for 365 days of coverage).

Problem with most agents selling this HHC plan is that they have no experience in the Health Markets field. Ask any agent that sells LTC, Medical insurance or MedSups. They will tell you that they are involved with their clients at claim time, either with a phone call or help in filing an initial claim. That is why we get paid the big renewals.....LOL.

I agree that Kemper does have issues with agents and does need some management changes to have an effective change..... They are slow in this area and they must get better to be taken seriously by agents.
 
Not knowing the specific details in your Case... HHCA Services alone does not mean they are covered by the Kemper HHC policy.

They must be a licensed/certified provider of HHCA Services. Not all companies are licensed or their employees are licensed thus the services would not be covered. Plus there is a daily max of $40/day up to 60 days (except for TX-Different Schedule for 365 days of coverage).

Problem with most agents selling this HHC plan is that they have no experience in the Health Markets field. Ask any agent that sells LTC, Medical insurance or MedSups. They will tell you that they are involved with their clients at claim time, either with a phone call or help in filing an initial claim. That is why we get paid the big renewals.....LOL.

I agree that Kemper does have issues with agents and does need some management changes to have an effective change..... They are slow in this area and they must get better to be taken seriously by agents.

This is so true and I am for the most part. Even though I tell all these people with indemnity programs (whether it was a HHC, Cancer, HIP or other) to CALL ME when they have a claim, they just do what they want. I can nail it in their head, to no avail.
 
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