Stacking Policy's with One Insurance Company

[Snowbvi]

I have a client that started claiming on his LTC policy's. He picked up two different long term cares with different riders about 5 years apart.
140 from one, 160 from the other.

He showed me how he faxes his claims in:
"Claim for policy 12345 and 56789"
Care notes show 6 hours of care at $25
Invoice shows 6 hours at $25

Insurance company cuts a check for 150 for one policy, and 140 for the other policy.

I don't get it, it's all inside the same company, he hid nothing, this is how every claim has been paid. Everything, the care notes, cover page with both policy's listed, the invoice, it all is in one fax.



I have no idea what to tell him and I want to try and get my ducks in a row before I call home office.

 

[Newby]

I have a client that started claiming on his LTC policy's. He picked up two different long term cares with different riders about 5 years apart. 140 from one, 160 from the other. He showed me how he faxes his claims in: "Claim for policy 12345 and 56789" Care notes show 6 hours of care at $25 Invoice shows 6 hours at $25 Insurance company cuts a check for 150 for one policy, and 140 for the other policy. I don't get it, it's all inside the same company, he hid nothing, this is how every claim has been paid. Everything, the care notes, cover page with both policy's listed, the invoice, it all is in one fax. I have no idea what to tell him and I want to try and get my ducks in a row before I call home office.

What is the question? He just has two policies.

He could have 10 policies if he wanted to. Not anymore since he is on claim.

 

[Snowbvi]

He is sending them a bill for the daily amount, but they keep paying the daily amount on both.
6 hours in claims but he is getting 12 hours reimbursed. The claim notes are clear, 6 hours, but because the fax cover has both policy numbers they are paying on both. Is this normal?

 

[Newby]

He is sending them a bill for the daily amount, but they keep paying the daily amount on both. 6 hours in claims but he is getting 12 hours reimbursed. The claim notes are clear, 6 hours, but because the fax cover has both policy numbers they are paying on both. Is this normal?

Sounds like he bought $300 in daily benefit. I'm no LTC expert but the policies I've sold go by daily benefit not hourly.

It's a cash benefit triggered by needing assistance with daily living not matching up with providers bills like medical insurance.

With LTC some of the money may be needed to modify his home or things like that. It won't match when a caregiver is there with him.

 

[Arthur Rudnick]

Something is missing from the equation here.

Newby, why are you assuming that the policyholder has a cash benefit policy? If it was a cash benefit, there would be no reason to submit bills or receipts in order to be paid.

It appears that the company is paying twice for the same claim, which they should not be doing. The cost of his care is $150 and he's receiving twice the amount.

Snowbvi, what company is your client insured with?

 

[Newby]

Something is missing from the equation here. Newby, why are you assuming that the policyholder has a cash benefit policy? If it was a cash benefit, there would be no reason to submit bills or receipts in order to be paid. It appears that the company is paying twice for the same claim, which they should not be doing. The cost of his care is $150 and he's receiving twice the amount. Snowbvi, what company is your client insured with?

There is not enough info to know. But he says they submit the bill for the daily amount. And it sounds like the daily amount is consistent.

 

[Snowbvi]

Bankers life and casualty is the company.
Daily benefit on policy one is 140, daily on second is 160.

He is only submitting care notes and invoices for $150, so half of what he could bill for. When he sends in the claim his cover page he has both policy's listed.

Then a few weeks later he gets two checks in the mail. $150 and $140 with a note saying that out of the $150 the daily limit cap is 140.

 

[ltcadviser]

Bankers life and casualty is the company.
Daily benefit on policy one is 140, daily on second is 160.

He is only submitting care notes and invoices for $150, so half of what he could bill for. When he sends in the claim his cover page he has both policy's listed.

Then a few weeks later he gets two checks in the mail. $150 and $140 with a note saying that out of the $150 the daily limit cap is 140.

Not surprising. I know a life insurance agent that once received two $8000 commission checks from them for the sale of one policy.

 

[Snowbvi]

I have heard story's like that as well. The part the concerns me is 6 months latter they go, "oh, we over paid? We want it all back".

Trying to figure out if this double payment on the ltc is normal for them, two policy's, two payments.

Head in the sand does not work well, but I also don't want to stir the pot with bankers by asking if they make a habit of paying twice.

 

[Mr_Ed]

I have heard story's like that as well. The part the concerns me is 6 months latter they go, "oh, we over paid? We want it all back".

Trying to figure out if this double payment on the ltc is normal for them, two policy's, two payments.

Head in the sand does not work well, but I also don't want to stir the pot with bankers by asking if they make a habit of paying twice.

once they discover the error, they will request that he refund the money or they will simply apply the misappropriated funds to future claims.