Long Term Care Health Insurance? More likely Living with the Kids

Seattle, WAIncreasingly, the families of policy holders are finding that their parents' long term care insurance is being denied. There could be multiple reasons, but one thing is certain: the insurance companies weren't prepared for so many claims. There are more people living longer and they are in need of assisted living or nursing home care. But they may wind up moving in with the kids.

Heather (not her real name pending a lawsuit) says Conseco long term care insurance refuses to pay for the care of her mother who has Alzheimer's disease, even though her parents paid into a policy for 15 years. "My mother was diagnosed about six months ago and we decided that we could no longer care for her without help," says Heather.

"We contacted and interviewed agencies that the local VNA suggested and we hired 2 separate agencies," Heather explains. "We then submitted all the proper documents and allowed a Conseco nurse to come out and interview my mother and see if the care we have chosen is appropriate.

This nurse filed her report stating that we can only have 8 hours of care daily. But my mother's doctor and the policy says my mother is entitled to have 24 hour care. As it stands, Conseco refuses to pay for the home health aid, who is a CNA from a state licensed referral agency. Basically they are hoping that we put my mother in a nursing home so that some of her care is paid for by Medicare; that way, their obligation to her regardless of the premiums she paid is lessened. In the meantime, my mother is living with us…"

Sean (not his real name) is in a similar dilemma. "Bankers United (which was purchased by Life Investors) has been giving me the run-around for several months," he says. "I have had to move my mother from assisted living facilities three times and the last move caused her—because she was so distressed—to fall and break her hip. Still the insurance company will not approve coverage and I am out-of-pocket about $50,000...so far.

"Life Investors is engaging in bad faith insurance practices by systematically engaging in tactics and policies designed to avoid payment and provision of contracted services." Insurance companies such as this one--and Conseco--have many tactics that seem to be designed to make you give up.

"The lack of returned calls, non-response to correspondence, failure to process communications and the dumping of all calls and correspondence into a centralized call center rather than the provision of a Personal Care Advisor (as specified in the contract) is unacceptable and has cost both myself and my mother months of effort and financial loss," says Sean.

Sean is more than frustrated with Life Investors. Last summer he provided them with a list of facilities to review. He placed a deposit on one home that his mother prefered, to make sure she will actually have a room (apparently there are waiting lists at many facilities). According to the administrator at the facility, Life Investors did a site inspection but they refuse to provide information regarding who did the review and the outcome. "A representative refuses to provide the contact information and states that they have not yet received the review package," says Sean, "and now this rep will no longer even take my calls and will not accept transfers from the call center representatives."

Sean has to move his mother from rehab this week and needs assurances that the facility will be covered, otherwise he will be getting the spare bedroom ready. He may need a lawyer to get that reasurrance.