Sunday, December 30, 2007

2007 Year End Wrap-up, Part I

My extended silence blogside of the last few months is due to a variety of inter-related things: battles with 2 different types of insurance companies, learning more about the ins and outs of DME (durable medical equipment -- aka wheelchairs, crutches, and the like), becoming more disabled, tuning in to the political fray of the Presidential primaries, and turning 50. I've been trying to process these experiences and come out on the other side with some take-away lessons/messages, and am only moderately successful.

First Tale of Insurance -- The Long Term Care Variety

My employer, West Coast Ivy, offers group Long Term Care (LTC) Insurance for its employees at quite reasonable rates, as these things go. Years ago, I read Suzy Orman's advice that the best age at which to sign up for LTC insurance was 55.

In summer of 2006, I went to a local Book Fair, where a woman with a LTC booth told me I should apply for it immediately, and seemed in doubt that I could get it, even though my employer had the group plan.


In an uncharacteristic burst of naivete, I had thought that because of the nature of a group plan, I would not have difficulty being accepted for the LTC policy, and I applied for it in the Open Enrollment period of 2006, which was in November of 2006.

The initial application form asks questions about cancer, high blood pressure, heart disease -- in other words, the big, bad diseases, and whether you've been diagnosed with them. All "no". The only question with a "yes" answer was something like "have you needed mobility assistance in the last 3 years, such as a wheelchair or a walker?"

That "yes" prompted my first rejection -- to make a long story short, I went back and forth with them from 11/2006 to 9/2007, when they finally rejected me with no further opportunities for appeal. They said that they based the final denial of coverage based upon information they received from my primary care doctor and my dermatologist.

Ironic Twist

After the final denial, I was debating about whether or not to request copies of what my doctor's had said -- since the insurance company had already lied to me about what the report of a phone interview had contained, it seemed like it might be worth seeing what was said -- but I was pretty sick of the whole thing by then.

Before I could suck it up and write them yet another letter, my employer announced that for "this year only", all employees would be able to apply for the LTC insurance with no medical review -- i.e., guaranteed acceptance. This "guaranteed acceptance" also occurs within the first 30 days of hire for new employees -- but I was 37 at the time, and totally broke, and hadn't thought that would be my last chance to apply...

So, I applied again, in 2007's Open Enrollment period (for insurance year beginning 2008), and received a letter signed by Jody Ross congratulating me on my acceptance. Ms. Ross was also the signatory of the numerous letters of the past year's struggle, but she did not acknowledge this (it may well be a pseudonym -- I'd certainly use one if I had that job.)

Lessons Available, More Questions to Come

My boss, whom I had kept apprised of my struggle all year actually called me at home when she got the letter announcing this year's special acceptance policy. I spent the next month trying (with much success) to get everyone in our office to sign up.

For me at 50, the cost will be $100 a month, for the highest coverage available currently: $300/day, in an assisted-living facility, and $225 a day in my own home. There is a one-time 90 day waiting period; you must have lost the ability to perform 2 or more ADLs (activities of daily living) without "supervision" (to cover cognitive deficits) or assistance in order to trigger coverage. There is a built-in inflation provision, so that over time, both the premiums and the coverage will increase proportionately.

  • Why I fought the rejection/denial of coverage: Since it is a group policy, I thought (mistakenly, apparently) that there was a higher degree of insurability available to me as a member of a group. It turns out that most of the people in my office were rejected on the first level of application, for very different reasons: one person answered "yes" to having seen a psycho-therapist in the last 3 years, one person had high blood pressure.

In other words, LTC insurance is just like most other types of insurance -- they don't want to insure you if you have any degree of likelihood of ever collecting benefits. Therefore, if you are currently very healthy and have not been diagnosed with anything, but you think you have a reasonable chance of needing assistance down the road (even if the road seems very long now because you're still pretty young), you should at least consider signing up for LTC insurance now.

  • Did you know that the cost of the premiums of LTC insurance are NOT TAX DEDUCTABLE, nor can you use your Health Care Flex Plan to pay them? I was floored by this, as it seems to me there is a huge public policy interest in getting people to insure themselves for this kind of care. WTF?

  • The RN that conducted my phone interview (which was during the first third of my struggle) told me that they denied everyone who said "yes" to ANY of the questions on the initial application. This reminded me of the legendary rate of denial of first applications for SSI -- regardless of the documented level of disability. I asked her if she knew what percentage of people appealed this initial denial but she said she didn't know.

I think a tremendous number of people take "no" for an answer. I never really thought I could win this appeals process, but I also really bristled at the idea that they were denying me solely because I use a power wheelchair for mobility. That seems to me to be clear discrimination -- except for my mobility impairment, I am quite healthy, and do not and have not ever received in home support services. In other words, they denied me coverage without any additional information in to my diagnosis or prognosis. Early on, even thinking I would ultimately lose, I decided to make them work for it.

And, who knows? Maybe the number of rejections and complaints by my fellow employees might have led to this year's "free pass". I feel certain they didn't do it out of the goodness of their hearts.

More 2007 fun to come...