Stacking Policy's with One Insurance Company

[yankee466]

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.

Under the policy language heading of "Non duplication of Benefits"...which they all have....some carriers will specifically include language of not duplicating payment if covered by "other LTC coverage", whereas others only talk about duplication with government programs, like Medicare, etc.....and no mention of a second LTC policy. Maybe some do think if you pay for two plans, you deserve to get reimbursed twice!!! although it sounds a little like fraud to me. Does a Banker LTC ap even ask about the existence of prior coverage like everyone else seems to do?

 

[Newby]

Under the policy language heading of "Non duplication of Benefits"...which they all have....some carriers will specifically include language of not duplicating payment if covered by "other LTC coverage", whereas others only talk about duplication with government programs, like Medicare, etc.....and no mention of a second LTC policy. Maybe some do think if you pay for two plans, you deserve to get reimbursed twice!!! although it sounds a little like fraud to me. Does a Banker LTC ap even ask about the existence of prior coverage like everyone else seems to do?

I've seen people take an LTC policy with $50 per day fixed benefit and later take a 2nd one with $100 per day benefit.

If they go on claim, don't they get $150 per day? What am I missing.

 

[Arthur Rudnick]

originally posted by newby

I've seen people take an LTC policy with $50 per day fixed benefit and later take a 2nd one with $100 per day benefit.
If they go on claim, don't they get $150 per day? What am I missing.

Other than a cash-indemnity policy, as far as I know every carrier has a non-duplication of benefits clause.

A reimbursement policy is not supposed to pay more than the actual cost of care.

I believe if 2 policies are purchased from the same company, it's the option of the policyholder as to which policy to submit a claim first. You can use the benefits of one policy first and then can utilize the second policy, once the first policy's benefits have been exhausted.

If the cost of care exceeds the benefit of either policy, then both policies can be utilized at the same time.

But again, in no scenario, is a reimbursement policy supposed to pay more than the cost of care, which appears to have happened in this case.

Mr_Ed is correct. If the error is discovered, Bankers will either charge the policyholder back for the over-payments or deduct the excess amount from future benefits.

But.....................
Keep in mind that we're dealing with Bankers and if history is any guide, they will never discover their mistake unless someone brings it to their attention.

 

[hawaiiguy]

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.

While the carrier is clearly double paying mistakenly,perhaps, if he would just reference the policy that covers the cost they would just pay on one.

 

[goillini52]

I've seen people take an LTC policy with $50 per day fixed benefit and later take a 2nd one with $100 per day benefit.

If they go on claim, don't they get $150 per day? What am I missing.

I agree with this. What's the difference in taking out a $50 a day policy and a $100 day policy with the same company and taking out a $150 a day policy. If it was wrong, they wouldn't issue the 2nd policy. As long as the amounts combined are within the company's daily limit that can be issued, why shouldn't both policies pay?

 

[Arthur Rudnick]

originally posted by goillini52

I agree with this. What's the difference in taking out a $50 a day policy and a $100 day policy with the same company and taking out a $150 a day policy. If it was wrong, they wouldn't issue the 2nd policy. As long as the amounts combined are within the company's daily limit that can be issued, why shouldn't both policies pay?

What's wrong with this?
In this case the policyholder's cost of care is $150/day and he's being reimbursed $300/day.

Read any reimbursement policy on the planet. Not one will pay a policyholder any more than the actual cost of care.

 

[goillini52]

originally posted by goillini52



What's wrong with this?
In this case the policyholder's cost of care is $150/day and he's being reimbursed $300/day.

Read any reimbursement policy on the planet. Not one will pay a policyholder any more than the actual cost of care.

Well both policies together total $300 a day in benefits. I haven't sold LTCI in over 10 years, but there used to be policies that paid a set amount per day regardless of the incurred charges, and others that paid the incurred charges up to the daily amount.

 

[Arthur Rudnick]

originally posted by goillini52

Well both policies together total $300 a day in benefits. I haven't sold LTCI in over 10 years, but there used to be policies that paid a set amount per day regardless of the incurred charges, and others that paid the incurred charges up to the daily amount.

OK, let's try to make this easy to understand..........

1) Non-Duplication of Benefits
If You have more than one long-term care insurance policy or certificate issued, We will reduce the benefit amounts payable to the extent necessary, so that the combination of Benefits under all of these policies and certificates will not exceed one hundred percent (100%) of the actual charges for Covered Services.
2) Right To Recover An Excess Payment
If, at any time, We make a payment in excess of Benefits payable under the Policy (“Excess Payment”), We have the right to recover such Excess Payment from any person to whom, or for whom, or with respect to whom, such Excess Payment was made. In the event that such Excess Payment is not returned to Us within 60 days of Our request to return the Excess Payment, We may deduct the Excess Payment from Your future Benefit payments, if applicable and where permitted by law.

 

[goillini52]

originally posted by goillini52



OK, let's try to make this easy to understand..........

1) Non-Duplication of Benefits
If You have more than one long-term care insurance policy or certificate issued, We will reduce the benefit amounts payable to the extent necessary, so that the combination of Benefits under all of these policies and certificates will not exceed one hundred percent (100%) of the actual charges for Covered Services.
2) Right To Recover An Excess Payment
If, at any time, We make a payment in excess of Benefits payable under the Policy (“Excess Payment”), We have the right to recover such Excess Payment from any person to whom, or for whom, or with respect to whom, such Excess Payment was made. In the event that such Excess Payment is not returned to Us within 60 days of Our request to return the Excess Payment, We may deduct the Excess Payment from Your future Benefit payments, if applicable and where permitted by law.

No need to make it easy to understand...I'm not stupid. I guess things have changed since I sold LTCI. I'd think that UW would've caught that and not issued the 2nd policy.

 

[yankee466]

No need to make it easy to understand...I'm not stupid. I guess things have changed since I sold LTCI. I'd think that UW would've caught that and not issued the 2nd policy.

having two policies not the issue. reimbursing twice for the same claim is the issue. UW would not be involved. If someone has two $150/day reimbursement policies, and there are legitimate receipts for $300/day, then both policies should pay the $150. The original poster described a $150/day total claim with both policies basically paying $150 each. Therein lies the problem, depending of course on the policy language and how confused the carrier may or may not be.