Advice Needed
Advice Needed
I'm not sure whether or not this belongs in this section of the Forum, but since it's med related, I'm including it here. As my wife and I approach the age of retirement, and since we don't have a massive portfolio to draw on, we're considering long term care insurance. Well, we asked our financial-planning person for advice on the underwriting process we'll need to go through...you know, "in the past 10 years, what surgeries, conditions, meds" etc.? Well, since he is our friend, he offered to get us some quotes from a couple of the major LTC companies, using medical information supplied by us. I included RLS, PLMS, along with a history of joint-repair surgeries, as well as the clonazepam, Neurontin, Trazodone, etc. meds that I'm taking for the RLS/PLMS and insomnia, and it looks like because of these, I'm a "high risk" kind of guy, and I don't think I'm going to be able to afford this insurance. Have any of you run into a similar situation in applying for either life or long term care insurance? How did you handle the medical disclosures? ---Andy
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ViewsAskew
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Wow. That is not a good situation. I hate insurance. I don't know what the solution is, but what we are doing in the US seems not to be the best.
I've not had to deal with this yet, but my partner and I have both had issues with regular insurance. I don't know if it's true, but I've been told that they can find out stuff, so coming clean in the beginning is better, or they will drop you if they find out, and that might happen during a claim. Not a good situation. That said, I can't imagine how RLS could put you in a high-risk category! Do you have to include every drug you've ever taken, or what you are taking at the time you apply? If not every drug, I'd seriously consider changing my drug regimen for a few months, even if I had to suffer.
I hope you find out more info about this.
I've not had to deal with this yet, but my partner and I have both had issues with regular insurance. I don't know if it's true, but I've been told that they can find out stuff, so coming clean in the beginning is better, or they will drop you if they find out, and that might happen during a claim. Not a good situation. That said, I can't imagine how RLS could put you in a high-risk category! Do you have to include every drug you've ever taken, or what you are taking at the time you apply? If not every drug, I'd seriously consider changing my drug regimen for a few months, even if I had to suffer.
I hope you find out more info about this.
Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
I'm no Long Term Ins. expert, but from what I know they'll research your history and find out what they need to know. I wouldn't think RLS would make you "high risk" but I guess the joint-repair surgeries would do it. Insurance is quite skilled at NOT paying people but I'm glad you have good friends to help out.
If you have osteoarthritis or bone density problems then that would maybe increase the risk.
IMO it depends on how "massive" your portfolio is. If it's not a huge nest egg, then would the $200 a month premiums be a hardship that would be worth saving a somewhat small nest egg?
One very different option is that there are ways to legally transfer assets (in some states) and put them in a trust and thereby qualify for Medicaid when it's needed to pay for a nursing home /home health while the trust helps the spouse who lives in the community. it is quite complex and an elder law attorney would be more effective to assist I think. But this type of trust isn't used until it's needed since it's not insurance.
http://www.floridamedicaid.com/qualifie ... _trust.htm
Of course, there's even more legal ways in some states to transfer money away from your account in order or Medicaid to not recognize it. The laws constantly change though so I'm not up to date. Good luck! Swiss bank accounts???
If you have osteoarthritis or bone density problems then that would maybe increase the risk.
IMO it depends on how "massive" your portfolio is. If it's not a huge nest egg, then would the $200 a month premiums be a hardship that would be worth saving a somewhat small nest egg?
One very different option is that there are ways to legally transfer assets (in some states) and put them in a trust and thereby qualify for Medicaid when it's needed to pay for a nursing home /home health while the trust helps the spouse who lives in the community. it is quite complex and an elder law attorney would be more effective to assist I think. But this type of trust isn't used until it's needed since it's not insurance.
http://www.floridamedicaid.com/qualifie ... _trust.htm
Of course, there's even more legal ways in some states to transfer money away from your account in order or Medicaid to not recognize it. The laws constantly change though so I'm not up to date. Good luck! Swiss bank accounts???
Andy, timely post as I have just been involved in doing this the past week. Not sure you can get by the medical disclosure as typically once you actually make a formal application for the long term coverage they will ask for a release so that they can obtain medical records usually from your primary care and specialists. Don't think they just take your word regarding medications, health status etc.
I went through one of the on line brokerages who, based on the preliminary information you provide, obtained coverage quotes from a number of companies. They do this quickly but it is not a formal application. I was told that all companies from whom they obtained quotes would not insure me because of 1) my vicodin usage (for rls and shoulder/back) and b) the possiblilty two near future surgeries (relatively routine). My rls, per se, was not a reason for which they would not give coverage. The brokerage obviously does not deal with every insurance company. They will tell you which companies and their criteria for dealing with companies such as their insurance rating, how many years in business, rate hikes, etc.
The good news. The rep. indicated that if I were to stop using vicodin for 6 mos. and resolve the surgery issues either by indicating I am electing not to have them or to successfully complete the surgeries that I would then be insurable--all other things being equal.
Apparently, regular use of narcotics even for medically sound reasons is a no-no other than when prescribed following surgery or similar short term situations. I was told that Ultram was more acceptable in that it is technically not a narcotic but only in limited dosage of 100 mg. I'm not sure if that was a total dose per day or a maximum mg per dose. Have to get back to the rep on that.
In any event, your lawyer perhaps did something similar. I guess I would encourage you either through you lawyer, individual company contact, or through one of the on-line search companies to go through a similar process and actually get feedback in terms of what particular issues would prevent you from getting coverage. It may be that, similar to my situation, you would be able to dismiss those reasons in one way or another. Maybe not. But, it may be worth a try.
Also, despite the above, one company was willing to offer a "secured risk policy." The coverage was more limited and it was somewhat more costly. Still, in the event I am not able to resolve the issues for a more standard policy, it is still something that I will consider.
Hope this make sense. I learned a lot by going through the process. At worst, I hope this post will give some food for thought.
I went through one of the on line brokerages who, based on the preliminary information you provide, obtained coverage quotes from a number of companies. They do this quickly but it is not a formal application. I was told that all companies from whom they obtained quotes would not insure me because of 1) my vicodin usage (for rls and shoulder/back) and b) the possiblilty two near future surgeries (relatively routine). My rls, per se, was not a reason for which they would not give coverage. The brokerage obviously does not deal with every insurance company. They will tell you which companies and their criteria for dealing with companies such as their insurance rating, how many years in business, rate hikes, etc.
The good news. The rep. indicated that if I were to stop using vicodin for 6 mos. and resolve the surgery issues either by indicating I am electing not to have them or to successfully complete the surgeries that I would then be insurable--all other things being equal.
Apparently, regular use of narcotics even for medically sound reasons is a no-no other than when prescribed following surgery or similar short term situations. I was told that Ultram was more acceptable in that it is technically not a narcotic but only in limited dosage of 100 mg. I'm not sure if that was a total dose per day or a maximum mg per dose. Have to get back to the rep on that.
In any event, your lawyer perhaps did something similar. I guess I would encourage you either through you lawyer, individual company contact, or through one of the on-line search companies to go through a similar process and actually get feedback in terms of what particular issues would prevent you from getting coverage. It may be that, similar to my situation, you would be able to dismiss those reasons in one way or another. Maybe not. But, it may be worth a try.
Also, despite the above, one company was willing to offer a "secured risk policy." The coverage was more limited and it was somewhat more costly. Still, in the event I am not able to resolve the issues for a more standard policy, it is still something that I will consider.
Hope this make sense. I learned a lot by going through the process. At worst, I hope this post will give some food for thought.
This post simply reflects opinion. Quantities are limited while supplies last. Some assembly required.
Zack, I love you... My husband and i are also looking into long term care. It's higher than I thought and I have so much wrong with me. Including type 2 diabetes. One of the companies we are looking at is through AARP. Hoping maybe they may be more lenient. The prices are all about the same. I'll try to keep you up to date on what walls we run into. If they turn us down, we have 6 kids and 17 grandkids (and I'm not even 60 yet) maybe one of them will take over when the time comes...Pat
I was denied health insurance because of the RLS, PLMD and, strangely enough, high cholesterol. The thing is, in some states, there is a high risk insurance option offered through the state. Insurance companies have to pay into it to be able to deny people they consider high risk. I thought it was very strange, but this is the insurance offered to people with long-term high-cost disease and I found RLS in the same list as brain tumors. But, my understanding is that they pretty much have to approve you. The downside is that it is rather expensive, but not as much as paying for the treatment of these conditions out-of-pocket. I ended up getting insurance through my employer and that saved me, but you might ask a local insurance agent about this option for health insurance. Good luck. Please let us know.
At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us. Albert Schweitzer
I suppose the reason why the can not insure is because they can.
I perused the aarp site and some of their packages but did not make a formal or even informal application but I may just to make sure. I certainly am interested in what others uncover.
I think the web brokers are not likely to give you bad information as they make their money by getting people insured. So, I think they likely do a pretty good job with their research. Also, the lowest rate they quoted me if I were to be insurable was in line with other reasearch I have done and with similar options. Still, I probably will contact another on line long term care brokerage with the same info to see if I get ta simialr response. I thought the process with the brokerage rep was very informative and actually provided me with some good information that I did not digest on my own. I'd like to share just a couple things. Make sure that the LTC coverage you obtain is one that uses your doctor and not the insurance company as the one who decides if you need care. Apparently, with some companies they decide if you actually need care and not your doctor. Talk about managed care! Additionally, with the inflation protection... be sure you ask/know whether the percentage you choose, if any, is increased on a simple or compound basis. There could be a fairly large difference based on 10 or 15 years coverage. I think it is very important to understand the options and coverage subtleties so that you can compare apples to apples.
Anyway, hope this thread can stay a bit active as it may benefit some now but perhaps even more later.
D
I perused the aarp site and some of their packages but did not make a formal or even informal application but I may just to make sure. I certainly am interested in what others uncover.
I think the web brokers are not likely to give you bad information as they make their money by getting people insured. So, I think they likely do a pretty good job with their research. Also, the lowest rate they quoted me if I were to be insurable was in line with other reasearch I have done and with similar options. Still, I probably will contact another on line long term care brokerage with the same info to see if I get ta simialr response. I thought the process with the brokerage rep was very informative and actually provided me with some good information that I did not digest on my own. I'd like to share just a couple things. Make sure that the LTC coverage you obtain is one that uses your doctor and not the insurance company as the one who decides if you need care. Apparently, with some companies they decide if you actually need care and not your doctor. Talk about managed care! Additionally, with the inflation protection... be sure you ask/know whether the percentage you choose, if any, is increased on a simple or compound basis. There could be a fairly large difference based on 10 or 15 years coverage. I think it is very important to understand the options and coverage subtleties so that you can compare apples to apples.
Anyway, hope this thread can stay a bit active as it may benefit some now but perhaps even more later.
D
This post simply reflects opinion. Quantities are limited while supplies last. Some assembly required.
Thanks to all of you for helping me not to feel alone in this insurability issue. Ann, I think you're right about the disclosure up front...I've been told that if I withhold medical information at the front-end of the underwriting process, and that a disclosure is made later (possibly when I need the benefits of the LTC coverage), that benefits can be denied. It appears that RLS and other neurological movement disorders are still misunderstood by the medical and insurance industries, as are the meds used to treat them...the underwriting process will reflect this ignorance by simply placing me in a less than optimal rating position. Unfortunately, previous (as well as present) medication usage disclosures may surface whether or not I choose to reveal them up front, and so if this lapse in my disclosure might result in a denial of needed benefits later, then what value will the "insurance" have? And even though at present, I'm only using narcotics for this darned urinary tract pain that began a week ago, and using Neurontin, clonazepam, and trazodone to help me sleep through the RLS/PLMS stuff, still I don't think that I'd be willing to withhold the use of any prescribed medication to improve the quality of my life just to satisfy any underwriting process requirement.
Zach, I share your anger in this issue...it's just not right to require individuals who have been diagnosed with a disease and pain so serious as to warrant a medical doctor to prescribe any medication (narcotic or not) to suspend their use of these medications to satisfy insurance underwriting requirements!
Mark, thanks for sharing your experience and knowledge...we're going to contact an elder law attorney to get information regarding the legal issues of any "asset-depletion" requirements prior to becoming eligible for medicaid. (My mother has alzheimer's, and will probably be needing progressively higher levels of care than what my brother is presently capable of providing, and may need to apply for Medicaid assistance.) My wife and I can't make any LTC insurance decisions for ourselves without this legal information. While many LTC insurance companies may be "players" in the LTC market, many of them may not have the financial reserves needed to pay for the care of the many "boomers" that will be needing care in the future. I'm also going to do some research as you suggested to get a better idea of specifically what diseases/meds/past treatments might raise the underwriting "red flag", resulting in prohibitively high premiums.
Everybody, I share many of your feelings about this insurance stuff...it's not like we don't have enough to deal with with the disease we share, and now I'm introducing another gloomy topic to the forum. Sorry.
Ann (or any other moderators reading this thread), is it appropriate for me to post any future information about this topic here, or should I begin a new thread in another area of this forum?
Thanks again for all of you sharing here. ---Andy
Zach, I share your anger in this issue...it's just not right to require individuals who have been diagnosed with a disease and pain so serious as to warrant a medical doctor to prescribe any medication (narcotic or not) to suspend their use of these medications to satisfy insurance underwriting requirements!
Mark, thanks for sharing your experience and knowledge...we're going to contact an elder law attorney to get information regarding the legal issues of any "asset-depletion" requirements prior to becoming eligible for medicaid. (My mother has alzheimer's, and will probably be needing progressively higher levels of care than what my brother is presently capable of providing, and may need to apply for Medicaid assistance.) My wife and I can't make any LTC insurance decisions for ourselves without this legal information. While many LTC insurance companies may be "players" in the LTC market, many of them may not have the financial reserves needed to pay for the care of the many "boomers" that will be needing care in the future. I'm also going to do some research as you suggested to get a better idea of specifically what diseases/meds/past treatments might raise the underwriting "red flag", resulting in prohibitively high premiums.
Everybody, I share many of your feelings about this insurance stuff...it's not like we don't have enough to deal with with the disease we share, and now I'm introducing another gloomy topic to the forum. Sorry.
Ann (or any other moderators reading this thread), is it appropriate for me to post any future information about this topic here, or should I begin a new thread in another area of this forum?
Thanks again for all of you sharing here. ---Andy
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ViewsAskew
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Up to you where you put it. Might be nice here so we can see the "whole" story; then again, sometimes it's nice to have the "answer" all on it's own so people can find it easily. Uh-oh, how's that for no answer?
Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Andy, Sorry to hear about your mum. We had to do the Medicaid eligibility stuff for my mum's nursing home care. Fairly easy process but not much fun just because...
I did put in for some more on line pre-quotes to see if I get different results or learn more. I was going to complete the aarp application but got to thinking. Probably not a good idea to fill out too many formal applications unless you are fairly serious. Reason may be that if they do request records your doctor(s) may not be too happy about having to copy forms for multiple apps. Wonder if they are able to somehow share those. Probably not as the release may be pretty specific.
As far as ability to pay, I mentioned that the one broker I contacted only uses companies that have high insurance ratings as well as some other financially related benchmarks. In any event, if you do decide on a company you could always go to one of the rating services such as A.M. Best and get the scoop, at least, for their current status.
Keep us informed as to your progress. My best to your mum and family in this journey.
I did put in for some more on line pre-quotes to see if I get different results or learn more. I was going to complete the aarp application but got to thinking. Probably not a good idea to fill out too many formal applications unless you are fairly serious. Reason may be that if they do request records your doctor(s) may not be too happy about having to copy forms for multiple apps. Wonder if they are able to somehow share those. Probably not as the release may be pretty specific.
As far as ability to pay, I mentioned that the one broker I contacted only uses companies that have high insurance ratings as well as some other financially related benchmarks. In any event, if you do decide on a company you could always go to one of the rating services such as A.M. Best and get the scoop, at least, for their current status.
Keep us informed as to your progress. My best to your mum and family in this journey.
This post simply reflects opinion. Quantities are limited while supplies last. Some assembly required.
Ann,
If no objections, I'll follow through with any info/progress regarding the long term care topic here in this thread.
And thanks Mark for your consideration regarding my mother's condition...I guess many of us here share much more than RLS-related issues. That's one of the things that makes this forum special...that we can open up to others about such a variety of topics of living. I hope that your recent success with your sleep situation is still working out, and that for all of us here, we have a restful night. ---Andy
If no objections, I'll follow through with any info/progress regarding the long term care topic here in this thread.
And thanks Mark for your consideration regarding my mother's condition...I guess many of us here share much more than RLS-related issues. That's one of the things that makes this forum special...that we can open up to others about such a variety of topics of living. I hope that your recent success with your sleep situation is still working out, and that for all of us here, we have a restful night. ---Andy
Mentioned that I was going to contact another online broker with respect LTC just to see if there would be a different reponse particularly with respect to the vicodin/narcotic issue. Well, acutally did not get to 1st base. As soon as I mentioned vicodin to the rep and she looked it up on the computer she immediately gave me the same scenario. That is, of the ten top A rated companies they represent all would not issue a policy based on the vicodin use. Also, with respect to possible should surgery, was told that they would not issue a policy until 6 months after completing physical therapy. Was also told by this rep that Ultram was also on the no-no list. We discussed this and basically she said that the companies pretty much can do whatever the choose.
Anyway, I guess the lesson is that get the LTC early if you can before embarking on the narcotics and/or postpone any surgeries til after you obtain a policy (if you can). However, if surgery is recommended in a
medical report you still may have difficulty getting insured until you can somehow change the record to suit the company.
I am still going to try to make myself "insurable" if I can do so without risk to my general health. If I have to make some changes or decisions in the interim, I am thinking about calling the LTC rept to see if the computer data base indicates wheather, or to what extent, the dicision/plan will negatively impact insurability. Don't know whether the rep will do this but think it may be worth a try.
Also, I did double check some aarp rates informally, and, all things being equal, I think the plan the LTC broker came up with (assuming insurability) was signifiantly cheaper. So, perhaps, they may be able to come up with a better rate when researching more potential companies for any individual.
Sorry, for the lengthy post. Hope some of this might be helpful or food for thought.
Anyway, I guess the lesson is that get the LTC early if you can before embarking on the narcotics and/or postpone any surgeries til after you obtain a policy (if you can). However, if surgery is recommended in a
medical report you still may have difficulty getting insured until you can somehow change the record to suit the company.
I am still going to try to make myself "insurable" if I can do so without risk to my general health. If I have to make some changes or decisions in the interim, I am thinking about calling the LTC rept to see if the computer data base indicates wheather, or to what extent, the dicision/plan will negatively impact insurability. Don't know whether the rep will do this but think it may be worth a try.
Also, I did double check some aarp rates informally, and, all things being equal, I think the plan the LTC broker came up with (assuming insurability) was signifiantly cheaper. So, perhaps, they may be able to come up with a better rate when researching more potential companies for any individual.
Sorry, for the lengthy post. Hope some of this might be helpful or food for thought.
This post simply reflects opinion. Quantities are limited while supplies last. Some assembly required.
Just came upon a good long term care insurance website which might be helpful with respect to answering questions and becoming more knowledgeable about the topic in general:
www.MrLTC.com
www.MrLTC.com
This post simply reflects opinion. Quantities are limited while supplies last. Some assembly required.