By IKU KIRIYAMA
On Sunday, Sept. 20, I presented a forum on long-term care, hospice and caregivers at the Gardena Valley Japanese Cultural Institute with panelists Mike Umamoto, Umamoto & Associates, LLC; Gretchen Schaeffer, executive director, Hospice Care of the West; and Alice Nehira, owner, Loving Care, a caregiver agency.
I cautioned the audience regarding their choice of a long-term care insurance policy if they are looking into one. I was in a traditional policy with Metlife – note the past tense. I outlined the obstacles and run-around I went through to try to collect on a claim for my sister, Aiko Shinosaki, who passed away of cancer in April. I naively thought that the claim process would be a forthright, simple process. After all, she had paid for her policy since 1999. It was HER money.
To backtrack a bit – my mother died in 1999, after three years in a vegetative state from a stroke. During that time, I paid the hospital charges (she was at the now-defunct Bay Harbor Hospital on their convalescent floor in a private room) from her assets, which amounted to $45,000- $47,000 a year. Note that now that charge would likely be around $100,000 annually.
It concerned me because I knew my kids wouldn’t be able to pay that kind of money for my husband or me if our assets didn’t cover it. I called Aiko and her husband, Gene, and they came over and the four of us (my husband and I) purchased policies (formerly Travelers). We knew absolutely nothing – not a good way to make such an investment. That’s another story I won’t go into now. I believe more people are aware now because of the amount of information available.
Now, I know that Aiko and Gene actually didn’t need to buy policies. He was 72 (way too old to buy LTC and passed away four years later at 76), they had no children, and they were financially stable because he invested wisely. They could have paid for any care, as it turned out. Gene passed away of cancer and wouldn’t have qualified for care under the terms because he was still driving up to about three weeks before his death.
My husband died two years later in 2005 of cancer. He, too, wouldn’t have qualified until the last two weeks of his life. Aiko lived only 14 days after entering hospice. Since the doctor had said “weeks to months,” I decided to file a claim for the private caregivers she would be using even though I was doubtful that she, too, would survive very long. I just thought that since Gene’s and George’s money that went into their traditional LTC policy was like throwing money out the door, I would try to get whatever compensation I could for her.
The paperwork was voluminous, and since I was the sole family taking care of her, I decided it was useless to proceed. After she died, Metlife told me I could file for her estate to get compensated. I said “great” and started the process. Step 1, no problem. They asked for an invoice from Alice’s Loving Care. Sure, that would be expected. Alice gave me the invoice, I mailed it, and a few weeks later, I received a letter from Metlife that they hadn’t received it.
I called (Lynchburg, Va.) and spoke with the claims person on the letter. She said she didn’t receive it, even though I had attentioned it to her. She asked Alice to fax it. A few weeks after that, I received a letter that a fax was not sent. I called Alice, who said she had faxed it that day and had the confirmation number. I called back and told them, upon which they said it had come two days prior to our conversation (weird since it was faxed weeks earlier). I thought, fine, now they can settle it.
But, a few weeks later, Alice received a request to itemize all the services performed and the costs. She did that.
Now, into the fourth month, I received a letter (a cc) asking for three more things: 1) detailed billing statements indicating each date of service, and the amount charged for those services on those dates (bolded words are theirs), 2) intake assessment and initial Plan of Care, 3) Daily nursing notes and/or flow sheets.
I was furious. WHY were they asking for things piecemeal? Why not itemize and send a bulleted list in the FIRST letter? Alice’s caregivers (three on eight-hour shifts) had taken detailed notes on the same spiral notebook. I couldn’t find it and decided I had probably thrown it away while cleaning up two months later. I knew I had had it for at least two months. I told Alice to “forget it” and sent Metlife a letter.
I asked them why everything wasn’t spelled out at the beginning. And the items on the last letter were ridiculous. Would we put down each time a diaper was changed, the time and how much it cost? The caregivers are paid by the hour, not by the service. Also, they knew she was in hospice. The intake assessment was obvious – “she’s dying.” And the initial plan of care? There is no plan of care in hospice – only to give comfort. And I told them I did have a nurses’ log four months earlier. I told them it was obvious they have no intention of compensation.
I ignored the “final request” letter they sent since it was fruitless.
With that letter, I also canceled my policy, which was due at the time, because I decided after a few days that it would be ridiculous to throw good money after bad. Instead, I will set aside that same amount and more and be assured that THAT money will be here for my kids to use.
Later, researching online, I found a ton of complaints against Metlife, and ALL had the same problems and issues I had. The roadblocks and delays appear to be intentional.
So, for those of you who have traditional LTC policies, learn from my bad experience and do the following when facing care of a family member, whether at home or in a facility, and you think your company will compensate you:
• From the very first day of medical care becoming obvious, keep a detailed log in a three-hole binder of every day (do not skip even if nothing important happens – you could find that later it IS important), the time and the names of any doctors or other provider who performed a service. Conversations – who said what, when, and why.
• Record everything – medications, dosages, purpose, who administered it.
• If you enter a facility, prepare a letter for them to sign and indicate “intake assessment” and “plan of care” and then also a follow-up letter of same that would be for private caregivers. If the facility provides their own printouts, that should be adequate; just make sure the two items are covered verbatim.
• Keep receipts of everything. Note them in your notebook and clip the receipts together and place in a pocket of the notebook.
• Private caregivers (such as the ones provided by Loving Care): Use a separate spiral notebook and have them sign in each day. Time of arrival and time of departure. Also: their position (RN, LVN, CNA, HHA).
• Have them keep a detailed account of their shift. Anytime they do something – what, what time, any outcomes (e.g. rash on buttocks, applied xx ointment, etc.).
I don’t know what you would put about cost per service (as Metlife asked) since I doubt anyone would charge by the piece, i.e. diaper change, apply ointment, change bed pad, feed broth, give medication, etc. This is what is so ridiculous about Metlife’s demands.
My final suggestion: If you are not in a LTC policy and thinking of getting one, do not go the route I did with a traditional policy. Do your research and talk to a lot of people, and not just to those selling a product as you will not know if it is for you – speak with people who do not have a personal financial stake in what you do.
By the way, if anyone follows these suggestions and is successful, I’d be interested to know.
Iku Kiriyama is a retired educator and community volunteer. Opinions expressed are not necessarily those of The Rafu Shimpo.
Your experience with making a claim on a long-term care insurance policy is not the norm. The federal government commissioned an audit of the claims practices of the 7 long-term care insurance companies. They found that experiences like yours are very rare.
You can read more about the audit at the link below: