Complaints Against Long-Term Care Insurance Companies

What’s the worst part about long-term care insurance? Finding out your policy doesn’t cover what you need it to.

The long-term care industry needs help to compete with younger and healthier markets. But some insurance companies are finding new ways to survive.

The federal government recently began cracking down on long-term care insurance companies, claiming they are engaging in unfair practices and are not providing adequate consumer protections.  

Long-term care insurance helps pay for extended medical care to people who need help with Activities of Daily Living (ADLs), whether in a nursing home, rehabilitation facility, or living with in-home assistance. Broad coverage for nursing homes assisted living and home care. If you purchased long-term insurance coverage, you or your loved one may find it difficult to collect benefits because carriers are unable to pay claims.

We will look at 3 recent complaints about long-term care insurance companies and their practices, including scams, poor customer service, and high prices.

Delays and denials of benefits in claim processing

Most health insurers deny or delay long-term care claims without ever telling you why. If you are denied, you should ask for a reason and ask the company to reconsider.

Here are some reasons why your claim may be denied or delayed.

  • Your medical records were lost or not received by the insurer.
  • Your physician needed to send in sufficient medical records to support the treatment.
  • You need to meet all the necessary qualifications to receive benefits.
  • The insurance company is still reviewing the medical records.
    The NAIC also conveyed that it had identified a steady increase in the number of complaints regarding claim denials, including a 74% increase in the number of claim denial-related complaints between 2003 and 2006.

Unexpected premium hikes: Long-term care Policyholders’ Services

This type of complaint is usually heard from people about care insurance. Unfortunately, long-term care policyholders often receive unexpected premium hikes. Knowing your options to deal with this type of situation is essential.

You can negotiate the price of your premium or request a refund. However, if your health coverage is inadequate, you should consider buying a supplemental plan.

The cost of these plans is usually based on a percentage of your total premium. John Hancock is raising premiums an average of 40 percent for some policyholders this year.

Policy cancellations and denials under an underwriting

When underwriting your policy, your insurer is looking for specific things. This includes if you have had a recent loss or been sick recently. 

If you haven’t had a loss in quite some time, you might not get approved for an insurance policy. If you do get denied, don’t panic.

You can still apply for coverage with another carrier. Remember, underwriting is a numbers game. Your chances of getting approved depend on how many people you insure.

Getting approved the first time you apply may be challenging, but you can still get coverage. 

“Go about getting the documentation and making sure the providers provide it,” says Leslie Pierce, health division chief in the Pennsylvania Insurance Department‘s Bureau of Consumer Services.

A recent complaint filed with the Illinois Department of Financial and Professional Regulation alleges that some long-term care insurance companies illegally charge applicants without proof that they’ll need long-term care policies.

Simone Gell’s father was diagnosed with Alzheimer’s when he was 71 and eventually moved to an assisted living facility.

Do you know how to file a complaint against a long-term care insurance company?

The primary purpose of a complaint is to educate consumers about a company’s products or services and associated fees.

Complaint letters are often written by customers who are unhappy with the services they receive from a company.

Personal Contact with the Insurance Company

To ensure that your care is covered by insurance, you should contact your insurance company. If you do not contact them, you may not be able to use your insurance and may not receive the medical coverage you need.

File an appeal

You may file an appeal if you believe your insurance company needs to correct your claim. You must follow the directions carefully when filing an appeal.

You will need to send the appeal to the appeals department at your insurance company.

You can contact the Department of Insurance.

You can contact the Department of Insurance at 1-800-811-8113 or online at

They can help you find health insurance providers, and they can answer questions about your health insurance options. 

You can also contact them about filing a claim. They will guide you through the process, and they can help you get any money back you are entitled to.

Give your adult children a copy of the policy and let them know how to start the claim. Ensure they have the contact information for the insurance company’s claims department and the agent who sold you the policy.

Final Thought

A complaint is a statement that a person or business is dissatisfied with the services, products, etc., received by another person or company. 

For example, an angry customer can ruin a reputation and is often referred to as a “complaint”, especially when the complaint has been posted online.

Frequently Asked Questions

What is the biggest drawback of long-term care insurance?

The biggest drawback of long-term care insurance is that the premiums can be costly. Therefore, comparing rates from different companies is essential to find the cheapest possible.

Can long-term care insurance be cashed out?

Generally, long-term care insurance can be cashed out. To cash out long-term care insurance, you must pay the required premiums. You may be able to apply for a loan from the insurer.

Private long-term care insurance was all but impossible to get ahead of new tax However, she ended up only getting what she paid in $24,000.

What is one of the most important regulatory issues in long-term care insurance?

The regulations in long-term care insurance are very complex. One of the most important regulatory issues in long-term care insurance is how the insurance company pays claims. The most common method of paying claims is through a “cap” or “floor”.

This means that if the insured person’s medical costs exceed a certain amount, the insurance company will pay the insured person the lesser of their current expenses or a certain amount.

How long does underwriting take for long-term care insurance?

Underwriting for long-term care policy typically takes around three months. During this time, your application will be reviewed by our underwriters. 

Once your application is approved, we’ll send you a letter confirming the decision. If we decide to deny your application, we will send you a written notice explaining why.

Ron Gallagher, a deputy commissioner with the Pennsylvania Insurance Department, said, ”I don’t know that we have a real problem with improper claim denials.

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