Getting Long-Term Care Insurance to Pay

Thirty-seven years ago, in 1987, Linda Jahnke started a successful business selling Long-Term Care (LTC) policies. She diligently read every policy cover to cover to understand what she was selling to her clients. She sold every available insurance product and became well-versed in long-term care (LTC) contracts. Usually, that would be the end of the story, but it wasn't.

In 2010, twenty-one years later, Linda saw a client, “Marlene”, at an event and noticed she looked unsettled. Marlene, a former teacher who was always impeccably dressed, appeared disheveled that day. Concerned, Linda visited Marlene at her home and found that she was in poor health. Marlene had a caregiver who was only a few years younger and also struggling with aging issues.

Marlene suffered from chronic, debilitating pain, and Linda quickly realized she needed help. Linda attempted to arrange a more suitable caregiving situation and additional support, but Marlene refused. Respecting their professional relationship, Linda didn't push further.

However, Linda did offer to start Marlene's LTC claim, which Marlene accepted. Linda filed the necessary claim, expecting the policy to be activated so Marlene could receive the benefits for which she had paid premiums for decades.

Four months later, Marlene fell at home, worsening her pain. Despite this, she still had not received approval for the pain medication pump she desperately needed. Marlene told her caregiver it didn’t matter because her LTC had also been denied. That night, Marlene took her own life.

Linda can't say for certain if the claim denial was the last straw for Marlene, but it left her feeling shocked and guilt-ridden despite her efforts to help. She was also frustrated with the insurance company, as there was no apparent reason for the claim to have been denied. Linda knew she had sold Marlene a good policy.

Linda called the insurance company and learned that the claim had stalled because Marlene had missed multiple calls to schedule a required interview, and her caregiver had failed to submit additional forms. It was a series of “mix-ups”, but was this an isolated incident or a common problem?

Marlene had responsibly purchased the policy, but the insurance company let her down, and she failed to ask for help. Linda realized she needed to help her clients activate their policies, as insurance companies were not looking out for their best interests.

Over the next two years, Linda helped clients activate their long-term care (LTC) policies, but she was stunned by the constant obstacles and resistance from insurance companies, which seemed determined to avoid paying out claims. Linda's client list grew rapidly, revealing a significant need for her services. She decided to become an advocate.  As a Board-Certified Patient Advocate, Linda was able to create a thorough process for filing claims.

Jahnke Consulting specializes in navigating and managing long-term care insurance claims. Their proprietary claim protocol has resulted in a 99.9% success rate in claim approval and accurate benefit payments.  This unique process relieves clients of time-consuming phone calls, cumbersome oversight, and miscommunication. Families can focus on what they do best; offer comfort, companionship, and care. Not only do Linda and her team file claims, but they also assist in referring vetted care providers.  LTCi claims are organic ongoing events, the team at Jahnke Consulting supports the insured at every step in the process.

Today, no one offers the same service which Linda Jahnke has created. She is unparalleled in her field. While some insurance brokers help clients file claims, their five-step process ensures success. This oversight prevents minute details or requirements from slipping through the cracks which inevitably creates payment delays. Giving insurance companies no grounds to deny claims. Linda can work in all 50 states.

Some insurance carriers, actuaries and Third-Party Administrators may not appreciate Linda's pioneering advocacy.  Her record disrupts their calculations and pricing strategies (actuaries). However, to the 7.1 million policyholders, she provides peace of mind, ensuring their purchased insurance will be there when needed. Isn't that the purpose of buying insurance in America?

Initially facing resistance, Jahnke Consulting has established a lasting presence, fostering a working relationship with reputable insurance carriers. Linda takes pride in her work and emphasizes the importance of ensuring fairness by leveling the playing field.

Here are the Five Pillars that are the foundation of Linda’s model:

1. Claim Vetting and Contract Review: Linda reads all contracts thoroughly.  She advises an insured if they could be eligible and if their care providers would be approved as paid caregivers.

2. Medical Records: A case manager adeptly obtains necessary medical records, a common reason for claim closures. This is not an easy task.

3. Billing: The billing department sends invoices and care logs to carriers to ensure clients are paid promptly.

4. Accounting: The accounting team reviews statements to confirm accurate policy payouts, correcting frequent mistakes.

5. Nurse Advocacy: An RN attends required assessments, using the correct terminology to safeguard policies are activated and paid.

TIPS:

1. Don't Rely on Insurance Companies: They often make it difficult to activate your policy and can delay or deny claims. Most carriers are not selling products anymore, so they have no skin in the game to get positive reviews or provide good service. These policies were bought 20-30 years ago.

2. Act Quickly: Many policyholders wait too long to use their benefits. This is a mistake.

3. Beware of TPAs: Third-party administrators (sometimes referred to as care coordinators) work for insurance companies and may not prioritize your needs. They profit more when your policy pays out less or nothing at all.

4. Complex Contracts: Understanding your contract is crucial. Jahnke Consulting's expertise shines through, drawing on years of experience.

5. Expert Support: Jahnke Consulting collaborates with senior industry experts to ensure proper management of your policy benefits.

6. Cost: The first year involves a retainer. While the second year is optional, it's recommended for ongoing support for required recertification and additional claim filings that can pop up.

7. Mindset Shift: Treat your policy as a contract that requires understanding and education to obtain the benefits you bought.

8. Life-Changing Advantage: LTC policies provide significant support, allowing you a better chance to age in place, move to the care community of your choice, and offer relief to family caregivers.

9. Linda's Advice: Your 50s are the golden decade to buy an LTC policy. Aim for a solid monthly benefit of $5K (or higher) and a minimum 2% inflation rider.

Written by Jacqui Clark, CSA.

*Thank you to Linda Jahnke for discussing long-term care with me.

Linda Jahnke, a Board-Certified Patient Advocate (BCPA), is the founder and CEO of Jahnke Consulting Inc. With over 35 years of experience in the long-term care insurance industry, she specializes in interpreting long-term care policy language and advocating for clients to ensure their claims are paid. www.jahnkeconsultinginc.com (858) 513-8351