When Roses Reek — II

Elusive Justice Served – Lukewarm

Several developments occurred since When Roses Reek was published. When we left you, my father had been denied long-term care coverage because Mutual of Omaha (Moo) did not recognize his assisted-living facility as an eligible institution. If financial pickles can be dire and deep, in such landed my father. Signing off was the tipsy daughter, that’s me, avid to appeal Moo’s denial of coverage as best an ignorant layperson can, which did not bode a Jack-the-Giant-Killer scenario. The assault was more of a single sling from a dire pickle. Nevertheless, I wanted to see the conflict through, determined not to stop until defeat or success told me I could get back to normal life. But things happened. Curious things. Untoward things. Creepy things. Two, if you’re counting.

First and most horrible, my father informed me, rather smugly, that Moo had offered to refund him his premium payments – in full. I could feel his excitement through the telephone wires spanning the continents, and the Atlantic Ocean, too; a sense of triumph, as if he had pulled this off. He’d get something out of them after all, a bundle. When I mentioned the bundle would amount to a mere $40,000, he stood ready to defy the universe: “I’m telling them I’ll settle for $50,000.” I told Dad to hold off, that I was in the middle of writing the appeal to win the coverage for him I thought he should be getting, that I wanted to give that a try. But quite suddenly, my father couldn’t care less about any stupid appeal. He wanted the fifty thou. It took some of the wind out of my sails, but sail on I did.

Second, and not as wonderful as you would think judging from the way it made Mr. Litmus blue, Moo’s Ms. L called informing him that Moo recognized his assisted-living facility as eligible for coverage after all. I was crestfallen. It had taken me a while to get there, but I had worked myself up to ramming speed over this insurance thing, only to witness, long before coveted impact, the battleship sink all by itself.

The lessons hard won by these developments eclipsed any small triumphs my father and I may have gained.

The first lesson was to realize that the premium payback offered Dad was Moo’s attempt to buy him off, and cheaply at that, which meant that Moo had known from the day my father submitted his claim that he qualified for coverage, but just now realized he was going after that coverage with both barrels and had a fair chance of succeeding, because he did, in fact, qualify. Their move, transparent to everyone but Litmus, was to point out now what was stated in the policy for all the world to read: After 16 years of paying in, any insured person could have back all of the premiums, which of course also terminated the insurance policy. I don’t understand banking, but I do know most of us pay credit card companies up to 17% to use their paltry sums for periods of time exceeding a month. If he took his premiums back now, it meant Moo had gotten away with using Dad’s money for 30 years for free. Nothing wrong with that – for Moo. And the payback would release Moo from having to pay coverage for Mr. Litmus ever, who would indeed have cause to be blue.

The second lesson came when I spoke to Dad’s former home-care specialist, Ms. D, relaying to her the good news that after eight weeks of refusing to do so, Moo now recognized Dad’s assisted-living facility as eligible for coverage. “Of course, they do,” she said. “They had to.” “They had to?” I asked, my astonishment undisguised. “If a facility qualifies under state and federal law, which your father’s does,” she explained, “the insurance company has to accept it.” Oh ho. This tidbit had been adrift nowhere in the waters I had been breasting these last two months in my little whaling boat. But Ms. D knew it; she had known it right away. My thoughts darted to Ms. R, the woman in charge of handling long-term care insurance accounts at Dad’s assisted-living facility. While Ms. D saw Moo’s denial of coverage as invalid immediately, Ms. R’s response had been to tell Dad, oh, I guess you won’t be staying with us much longer.

Ms. R, who is a pleasant person, is not in league with Moo. She simply demonstrated indifference, incompetence, or if she protests at either of those reproaches, then let me call it trepidation to cast doubt on the judgment of an insurance giant from whom the facility possibly receives millions each year. Whatever her weakness, Ms. R exposed one of greater magnitude: willingness to turn away as a 94-year-old pensioner she had every chance to help got ground down before her eyes. Worse, she served as key player in convincing us that we did not have grounds for an appeal. How? By telling us so. One of us believed her. One of us did not.

Just because Moo now recognizes Dad’s assisted-living facility as eligible for coverage does not mean Moo is going to pay him anything. They are not. Mr. Litmus does not need assistance with at least three of the officially listed activities of daily living, they said, and for that reason is, as before, not eligible for coverage.

Let me assure you, we are on the case. Letters are being written, doctors consulted, and irate critiques, feckless though they may be, are being penned. Ramming speed!

3 thoughts on “When Roses Reek — II

  1. Great fortitude of mind on your part. Stark insensibility on the parts of several others.
    More great reporting and ruminating. I would like to say “keep us apprised” but what I would really hope for is resolution, a satisfactory end to this drama.

  2. Congratulations!! I’m happy to read about your success. I’m looking forward to getting the news what you both will finally do.

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