Monday 20th of March 2017 11:53:15 AM
My father could have been claiming on his LTC/HHC policy FOR at least the last FULL 5 YEARS. However, as many seniors, he 'could manage'. Plus, we paid a person to 'live and help him', which also included providing this person Free Room & Board. My Father's initial LTC/SNF Claim was paid within 60 days of filing it. I made certain that ALL the requested documents were collected, and set up within the full original Claims Packet. Then, I numbered the pages from '1 Of 199', '2 of 199', and did this all the way through '199 of 199'. This is the ONLY insurance company I have ever felt that I had to do this with, to take out what I call the 'Stupid Factor', to ensure that if they state, "We are missing [they Name Off one of the required/specific Claims support documents]." Then I can quickly respond, "Well, do you see that each page has what number it is, about the total number of pages, which is 199'’? Get the picture. Yes, this is what happened when I 'called to check the status of my father's initial submitted LTC/SNF Claim'. The lady on the other side had nothing to say when I called her out on where each Section of Required document started and ended. I asked her to "Please Count the Total number of Pages, and tell me if you have the same total that I have. If you in fact ARE missing some pages, then let's figure out which one(s) you are missing and I will FAX THEM OVER TO YOU RIGHT NOW." My comment was followed by complete SILENCE. When I asked her if she had everything she needed, she stammered out, "I think we do, if we find that we need any additional documents, then we'll be in touch". I was surprised when about three weeks later that Dad's LTC Initial Claims funds arrived for deposit. I was especially surprised this occurred [after years of helping Clients with Claims, that it occurred without having to threaten the S.H.I.P. Claims Department with 'beginning escalation at compliance, regulatory levels, and then ultimately resorting to legal escalation'. I must admit that during my post initial claim submission that I clearly outlined the 'course of action' when calling in to Conseco/S.H.I.P.'s LTC Trust's Toll Free number at 877-450-5824 to 'Check on Dad's Claim'.Well, the reason that I ended up having to write this grievance [posting here and quite a few other spots where consumers will be sure to find it], is that when I submitted my Father's final LTC/Hospice Claim which was not even two full months in length that this is the manner it was handled. REMEMBER, this is NOT the initial claim, and my father's entire final claim is a hospice claim and my father's policy has a ZERO DAY ELIMINATION PERIOD! Which if you do not know what that means, "Elimination Period = # of Days the Insured must pay their own way, prior to their policy paying". Also, just to clarify, my father's policy is a true indemnity policy, which means there is no coordination of benefits, like on the newer policies do. My father's LTC/HHC/Hospice Policy benefits pay "in addition to any other similar coverage, and pays directly to the policyholder/insured, unless benefits have been assigned over to the provider", which my Father's had/has not. I was shocked that I received a call from the S.H.I.P LTC TRUST CLAIMS Department. Well, that was until the lady began stating, "the purpose of this call to you Mr. ** is to inform you that we still need quite a bit of information". Well, well! Surprise, surprise!!! ;-) I knew they would screw up, I just needed to give them enough rope and time. I listened to her poor, pathetic excuses of "why it is going to take some more time to contact the Hospice Provider, have them gather all of the additional documents that we need, and then get them to us". I gave her all of the time she needed - that is, to continue to hang herself with a completely conflicting 'story', versus reality.My response to her was, "Ma'am [addressed her cordially and respectfully], I am in NYC right now on vacation with my family. FIRST, I am going to address your oversights swiftly, and be very direct on my outlook and future action options, which will depend upon whether S.H.I.P. Claims decides to correctly and in a timely manner processing ALL submitted 49 pgs. of my father's final claim. This is a subsequent claim. Again, please note, this is NOT the first time that we have recently filed a LTC or a facility type claim. In fact, for my father's final claim, there are Forty-one  pages, AND ALL pages are solely due to dad's Hospice care, which was provided to him during the last days of his life.Second, I called into S.H.I.P Claims and spoke direct to your CSR [which I have on record, and S.H.I.P has a recording of] prior to myself both faxing & then also shipping by USPS the same entire final claims packet into S.H.I.P. LTC Trust Claims Department. Your S.H.I.P CSR young lady I spoke to, who pulled my father's claims records stated that she could access my father's file. Your S.H.I.P Claims CSR also acknowledged that any future LTC/HHC/Hospice Claims, if future Claims documents are submitted soon, would be considered a 'subsequent claim'. After I explained to the CSR the claim I was getting ready to fax, and then send in by USPS is a Hospice Claim, your Claims CSR stated the exact documents that S.H.I.P. Claims would require, since this is not an initial claim.Third, I explained to this lady in detail the documents that I was told to put together and send in by their Claims CSR, is exactly the documents and support documents that had been faxed and sent registered USPS mail, which had also required a return signature card. Fourth, I mentioned having a full electronic copy that I could fax or e-mail direct to her right now, that is, if she in fact was missing any one or more of this Hospice Claims' 41 pages, and asked her to count through all forty-one to verify if they are all there. Guess what - of course they just happened to find ALL forty-one. Imagine that?!!Here is the final straw. Yesterday evening, my spouse brings me a check from our POB. You got it, it is short, and not a little short. It is like over $5K short. I have the original policy, a copy of the original application, and I will get my father's Hospice Claim funds. I have squeezed this unethical company so many times, helping aid insured's over the years that I have honestly lost count of the number of times that Conseco/Conseco Health Insurance Company/Conseco Sr. Health Insurance Company have coughed up thousands in additional claims. I am continually amazed by their lack of knowledge, especially now that it is supposed to be 'under regulatory supervision'. Trust me, that doesn't mean squat!Offer to fellow consumers: To any of consumer, if you are having claims Issues with this company, or any of their subsidiary companies, you are welcome to contact me. In the event, you are having problems in getting your Legitimate LTC/HHC/Hospice/Alternative Plan of Care, Cancer Claim, Heart Attack/Stroke Claim, ICU, or any other Conseco claim paid then communicate with me. My only request is READ YOUR POLICY FIRST. I know this sounds simple, however, I still get calls from agents asking me to decipher their consumers policy, typically because they are just too lazy to spend five to thirty minutes reading the policy.If you feel you can get results on your own, and hopefully my above message has provided you with some guidance, then feel free to, "Go get them yourself - and the best of luck to you". Last, please do not give up on pursuit of your matter! This is exactly what Conseco/S.H.I.P LTC Trust wishes you will do. If you give up, all it does is increase their profit margin!