Woman needs help again chasing care benefits

November 11, 2011 8:08:14 PM PST
If you or a loved one want to be prepared for the senior years, you may be considering long-term care insurance, but are they worth the expense? One couple had trouble getting their benefits. So the turned to 7 On Your Side not once, but twice.

This couple poured more than $60,000 into their long-term care insurance premiums. However, when they needed that nursing care as senior citizens, it was hard to comeby.

Last time we saw Beverly Joe she was fighting to get her husband's long-term care insurance company to pay for his long-term care. Now, she's fighting again.

"They started giving me all this trouble, taking their time," said Beverly.

Beverly's husband Jack had suffered a stroke that left him disabled. However, they had planned for this by purchasing a long-term care insurance policy back in 1996. It was expensive, up to $534 per month. Now Beverly figured it would pay off, but when she filed a claim for home nursing, she found benefits didn't come easy.

"They kept writing me and telling me, 'No, we can't pay her that much,'" said Beverly.

The company declined to pay the full benefits. So 7 On Your Side contacted her carrier, Senior Health Insurance of Pennsylvania, known as SHIP. The company reviewed the claim again and in the end, they did pay her an additional $4,092 in benefits. Beverly was relieved, but months later found herself fighting the company again.

"They take their sweet time and they try to put all kinds of obstacles in your path," said Beverly.

Jack had wound up in a nursing home and when Beverly received a bill, she filed another claim with SHIP.

"They sent me all these papers which was a claim form and I filled them all out," said Beverly.

But SHIP said it wasn't enough information. The nursing home provided more data, but the insurance company said it was still not enough.

"They said, 'You only sent six pages and they actually want 35 pages,'" said Beverly.

Beverly says she and the nursing home never received a clear idea what information the company wanted. Just a letter saying their time was running out.

"Saying, 'We can't hold this claim forever, so the deadline is Oct. 28th,'" said Beverly.

The letter said without that extra data, "We will be unable to pay your claim."

One day before the deadline, Beverly contacted 7 On Your Side again and again we contacted SHIP. Soon Beverly got the good news.

"Senior health care called and said, 'We received all the information,' in one day," said Beverly.

SHIP agreed to process her claim and promptly and soon after sent her a check for $7,000. The company said, "The requested information was finally received on October 27, 2011. SHIP never denied Mr. Joe's eligibility, however a bill was denied because we could not read the dates of service."

"I really am thankful to 7 On Your Side. All I did was call you and right away you do something about it," said Beverly. Before you buy a long-term care policy, go to the California Department of Insurance website and there you can look at the track record of many of the major companies.


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