This will have to be short as I need to run out. I have had numerous problems with getting my claim processed through John Hancock. First they gave me wrong information last September resulting in having to start the process all over again in January. After daily phone calls, nurse visits, often holding for an hour or longer!, mailing, faxing, refaxing, remailing, calling from both me and my home health agency, they FINALLY started paying and thankfully did pay retroactive since it was their error. So I thought everything was finally okay as of mid March.
But I now learn that they have not processed the bills sent from the agency since March 22. According to a long phone call with the claims department help number person, they have invoices from mid March to mid April. ALL this money came out of my checking account leaving me with NO CASH readily available and was a big shock to me. I thought by this time they were paying the agency directly.
They have given me numerous excuses: the assignment of benefits not received (finally resolved after numerous long phone calls and agency faxing at least four times); then the W-9 required by the agency was not received (also faxed four times with phone calls by me and the agency to Hancock.
At this point I am in a bad way financially as I don't have the cash available without cashing out my IRA to pay out of pocket for caregiving so haven't used any for awhile. (Caregiver problems another issue which I won't complicate this thread with.)
So I am told they have the invoices and the person acted as though they had been somehow overlooked and that she would call her supervisor and get right on it.
I called the "case manager for my claim at Hancock" yesterday leaving this information on her voice mail. Today she called me telling me how many claims they have there and I am just one of many and that some states are 15 day states and some are 30 so really they are not obligated to pay the claims as soon as they come in since they are so busy that mine may be at the bottom of a pile. WHAT????? I mentioned in all the phone calls we had before she had never mentioned this.
HOWEVER, she looked up VA which is where our policy was issued and told me it is a 15 day state. So then she went into a long story about "suppose you faxed invoice on April 1, then the time doesn't start running for processing legally until they somehow locate it there and date when it was officially received which could be 5 days from the date it was received. She then said in that scenario I might not be paid until April 23 since the 15 days are BUSINESS DAYS.
She is grasping at straws it seems to let me know that it is not really late, but even given that scenario invoices which were received by them on March 15 are LEGALLY OVERDUE from what I understand. The agency faxes them every single Tuesday. I have received no reimbursement since March 22 and now can not afford to have help here as I am too broke.
QUESTION: The agency recommended a few months ago when I was going through hell with them that I contact the Insurance Commissioner. I cannot easily figure out how to do that or even a number for Virginia with the little time I had to google.
No, I don't have an elder care lawyer. Yes, I saw one and our papers are pretty much in order, but she didn't seem too capable of helping me in the event of problems so I don't have one and can't afford one right now.
HELP????? ADVICE?????? Especially with regard to contact the insurance commissioner or whoever.
I really appreciate anything you all might know. I just finally got our house on the market, DH is in favor of the move but makes every single thing I do so difficult that i'm around ready to go stark raving mad. There are also some other pressing legal problems I have which I need to attend to but I really want to get on this now. I am so sick of being taken advantage of everyone I come into contact with and tired of this victim role. It's not me. Or it used to not be me.
Frequently on TV we see ads for "Joe Bornstein", an attorney who will handle problems with insurance companies, social security, etc. In his ads, just mentioning that you have retained him seems to get the problem solved. Maybe you should tell the person you talk to that if this is not settled in 2 weeks their next call will be from your attorney, even if you can't afford one. Also, some will get payment only if they get your case settled to your satisfaction. (Joe Bornstein is only in Maine)
Contact your local television station. Most stations have an "Action" person who will look into your problems. Most companies do not want bad publicity and will get the gears moving.
At age 59 1/2 you can hit your IRA penalty free, you can also use it to pay for health care penalty free before then.
Sounds like most insurance companies will pay, once you hold a gun to their head and they can see no way out of paying. The good news is that they are paying, If you have signed over the payments to the Health Care Agency, then they should be trying to help you get the money. You need cash now, have you looked at selling any assets you may have to meet the immediate need? Gold is at an all time high and if you have some jewerly that you could part with, it may help you get thru this. If your credit is good you could get a signature loan, at your bank,then pay it off once you get reimbursed. If you have a whole life insurance policy you could borrow against that. Perhaps you could rent a bedroom out for income. If you live in a large city, perhaps selling a car and use public transit . Just some thoughts for you to consider.
At the end of the day, they can not get blood out of a turnip. Do what you can, and know that you are doing your best.
Thanks all. I think I wore myself out today, laid down at 5 and slept deeply for a couple hours. Woke feeling depressed and so exhausted I would welcome an enforced hospital stay.
moors, things haven't reached selling the car stage, didn't mean to cry dire straits. it is more the shock and expense of bounced checks, inability to pay the electrician and various people I have hired to get this house on the market. And the worst of it is after fighting so long for eligibility for full time care I don't have any care at all because of the incompetence of a huge company like Hancock who openly aknowledged how badly they screwed up my claim forcing me to wait six extra months before I could finally get away for my respite from hell.
I am so tired of fighting.
I know they will reimburse me but the cost is too much with most phone calls requiring an hour on hold. They readily admit they are understaffed. I don't know how people do this without an advocate. it is taking an extreme toll on me and I have been fighting this battle since January.
But, one of my little Bichons thumped his tail against the sofa pillow whe I dragged myself up the stairs a few moments ago. I lost it and started crying while giving him a hug. I felt so grateful for that small moment of feeling acknowledged, appreciated. I told an old feed last week I used to live for "peak experiences" and now I live for a small moments and wonder how long that will be enough.
Terry, you are my hero! Here I sit feeling depressed & sorry for myself & all I have to do at this point is deal with my DH & his mood swings & anger. So then I come here & read all that you are dealing with & realize how relatively easy I have it right now. I also live for the small moments of happiness & also wonder how long that will be enough. (((HUGS))) to you!
Terry, I am in much the same boat with John Hancock...only they paid the CG agency directly...BUT..to the wrong address. Some twit in their office transposed numbers, but instead of cancelling checks and reissuing them, they have to "verify" the correct address. As though it wasn't on all the original correspondence and every invoice sent them! So, I too am broke waiting for reimbursement from my CG agency for my original direct payments to them. I'm bloody angry and tired of the run around...and sick of worrying every second about $$$.
Thanks for the warnings about Hancock. We don't have this outfit but for anyone out here who does, two warnings about how they do or don't do business is well worth noting.
As for me, I am dealing with the VA again...G--Almighty, they know how to reinvent the wheel! Now I have to go after the doctors since they say they have not heard from them...In the end the result will not afford more disability pay but I want dh rated at 100%. He is 80% now paid at 100% because he cannot work. But do I trust the Govt not to renig? Hell no! With the current state of affairs, who is to say they won't come back at some time and say " well you are 80% so now to save $$ we will only pay at 80%"...
Mimi: So glad to see your post. As I understand it (from VA social worker)... your dh would have free NH care either at a VA facility or another home the VA contracts with. Wasn't this a major concern of yours that you would have to pay for his care if he needed placement?? My dh has only 70% and he qualfies so your dh at 80% should also qualify also we qualify for 30 days of respite care a year.
In our wonderful country, you would think that companies and Uncle Sam would try to take care of those at the end of the line with dignity and respect. Shame on them!!!!
Losing our spouses to this dread disease is hard enough without the financial burdens on top of everything else!!!!
kathi37, ah a co-commisserator! Hancock was to be paying direct to the agency - have I already said this, losing mind - but they claim they need yet one more form. This W-9 form was first sent to them end of SEPTEMBER of 2010!!!!!!!! And then faxed again to different fax numbers requested by them at least FOUR TIMES. Because I now desperately need reimbursement for thousands of dollars of unpaid invoices I was afraid to have the agency fax it again now because JH warned me months ago that as soon as they received the Assignment of Benefits and W-9 and the agency had been approved the money would go directly to them and it might take the agency awhile to reimburse me.
LESSON TO LEARN FOR ALL: Even if you have the best possible LTC policy, try to keep a $5,000-$10,000 account with ready cash to pay upfront for those times when they are slow, inefficient, or just plain screw up. LTC policies are not meant for people who don't have some money it seems.
I have to wonder if this is a strategic plan on the part of the ins companies. For the months I was not officially approved due to their screw up but assured I would be reimbursed, I simply could not afford to pay out huge amounts of cash out of pocket. As it was on my respite from hell I had to pay over $2700.00 from a credit card since although he had been approved, the agency was not being paid directly (still isn't). I planned and cancelled three different trips in the months I was going through this process with them.
And I know this policy like the back of my hand. I've probably read it 5 times every word. I meticulously followed the requirements for the 90 day elimination period even posgtponing our vacation so that we would be here to employ a caregiver to accummulate the time for that week.
It should not be this difficult. John Hancock is supposed to be the gold standard in LTC. I googled them looking for complaints and they are rated as one of the top two with the fewest complaints.
So many days from January - March I would be calling them in response in an error sent by mail requesting information we already sent or to give them information they already had or to clear up something or other, and until these past couple weeks I literally was never on hold for less than 58 minues (I timed it). And then one person would tell me to only to take information from them and that the other people might be giving me wrong information and vice versa. It's nearly unbelievable. I would have a caregiver here for 4 hours hoping to get some down time and I would spend it all nearly every time dealing with JH.
After I hung up on the woman who is supposed to be my case manager or the person I call if I have problems, she has called here twice telling me I need to call her back. In her dreams. She said on the machine: "I was able to talk with someone here who is able to process the bills for your husband. If you would give me a call I can tell you when you can expect reimbursement. Please do give me a call." No way I am calling her again. I think it made her nervous when I spoke of the insurance commissioner. Wonder why she couldn't tell me when I could expect the money in her message. Every time I talk with her or anyone there they tell me they are recording the conversation and I've tried recording a couple myself just because they are so unbelievable. So I imagine she wants to be on record as having given me this information. She kept telling me "Terry, you have to understand.....we have lots of bills coming through here, not just yours;; you have to understand we have many different departments and it is not that easy to tell who is doing what; and on and on." I finally told her to STOP TELLING ME I HAVE TO UNDERSTAND. I don't have to understand anything. I told her I would make a deal with her. She stops telling me I have to understand and I won't try to make her understand what my life is like here!!!!!
So, now believe it or not I'm getting ready to go to an attorney. I got a ticket - I didn't due it I swear - and am fighting a ticket for the first time in my life. The penalty for fighting a ticket in this little good ole boys town is that the procesuting attorney during my so called "discovery court hearing" last month offered me two days in jail starting immediately. He said if I chose not to take it he would be seeking a longer jail term and that I better get an attorney. I was freaked and shocked and blurted out: "My husband has Alzheimer's. How can I go to jail?" He shocked me and my witness who was there with me by saying in the cruelest manner, "The state will take your husband." OMG. And so it goes..........as I said my life has become unbelievable. I know I was Hitler in my previous life or does living with AD just bring all kinds of other bad things heaped upon us?
Terry, I'm so sorry you are having such problems!!! It isn't much, but I'm sending hugs to you - I wish I could do more!(((((((((((((((((((((HUGS))))))))))))))))))
John Hancock seems to have gone downhill since a Canadian company bought them out a few years ago.
I would follow through with letters and calls to the insurance commissioner and anybody else you can think of like paper, radio and tv stations.
Make sure you write negative comments online about them - don't be shy about it. This is absolutely horrendous what they are putting you two through. As far as the 15 days - the agency should know that and it should be figured into their bookkeeping. To come after you is cruel. But,, then again they are probably well aware of the problems with John Hancock which is why they are not patient.
Terry, my DH has JH LTC insurance as well. Our experience with them is similar to yours but I think ours may be a little better after the initial experience. When I initially filed a claim with JH to use the LTC, they investigated us for 6 months trying to proved we had fraudulently completed the application. after granting them a face to face interview and answering all questions and releasing all medical records for DH, they continued to interrogate me. Finally I asked our attorney to deal with them. Yes, it cost some $$$ but JH finally approved the claim and coverage.
Our HHC agency sends the timesheets every week to JH, but often they claim they haven't received them and they need to be sent again. JH's policy is that they have 10 business days from the date of the receipt of the timesheet to reimburse. We have chosen to have the payments electronically deposited to our account and like you we have spent thousands of $ out of our savings to stay current with the HHC bills. After the initial 10 business day period, they should be sending payments every week since they get the timesheets every week. One of the problems we have is that the agency bills in advance and the timesheets are for the previous week so we are paying the agency bills in advance and then waiting for reimbursement on a timesheet that is a week old. The agencies know that the insurers don't pay on time - they just want their money.
Gosh I feel lucky, once I approved direct payment to the Home Health Agency, they have to deal with insurance Company not me. We have a Golden Rule policy and they only pay once per month and only pay for complete Months which means the Agency is on the hook for 45 days before they see any money. They do not tell you this stuff when they want you to buy it. I am glad we purchased it, but they do make you jump thru hoops before they shell out any money.
Finally a little relief. A very good meeting with my new attorney. Not only will he be representing me in my weird traffic case but also in a slip and fall resulting in a head injury medically referred to as Post Concussive Syndrome, the result being headaches going on two years this August. And he'll help me with a little property issue I have here where the "good ole boys" who run the public works dept. treat our property was if it is their own, blah blah blah. Living in this little town is nothing but drama.
Charlotte, the agency has been great. They are just doing what we always agreed which was to charge my checking account until such time as JH started paying them directly. As I said the faxed multiple times all the invoices and forms requested but there is always something JH finds themselves "missing." The agency didn't know that I thought JH was paying them direct when they made the deductions they did. The only error they made was in not notifying me of such large deductions as they promised they would. And the agency has agreed that they will no longer deduct from my account so I started a new caregiver today for a few hours. (exhausting experience)
NIght mare time for sure! I'm steeling myself for another call to JH this morning...at least I can improve my Spider Solitaire skills while on hold forever! I try to remember the old adage about using sweet instead of sour when talking with whatever representative I speak with,but usually end up furious. I simply don't have disposable income any longer, and don't know how long I can hold out. I have two CG agencies I'm currently working with, so double the trouble.
Today my machine had a message from another person from JH telling me the invoices they have now processed, the amount of the check, and that the check was cut yesterday. I think getting angry and telling them I was contacting insurance commission did the trick.
Used the new caregiver for first time the other day. Exhausting but finally was able to get out for awhile.