Conseco's Elimination Period: Read Between the Lines

Smithville, MO"I filed for Long Term Care Insurance and had no idea I would have to pay the first 90 days of home care to Conseco," says Charles, who thinks the health insurance company writes these contracts deliberately to mislead their policy holders. " If I don't pay this amount my wife will lose her caregiver; we are retired and I am digging deep into our nest egg to cover this cost."

Charles' doctor advised that he get visiting nurses twice a week to their home. His policy allows home care, assisted care and a nursing home. He opted for home care. Ironically, if Charles' wife went to a nursing home instead of receiving home care, they wouldn't have to pay a penny!

Charles says the agency that supplies the caregiver charges $142 per day (7 hours per day, 5 days per week). The cost of a nursing home? Add a zero to that figure.

"Last April I applied for long term care insurance for my wife," Charles explains. "She has emphysema and osteoporosis so she needs help with just about everything—she fell several times. I filed the claim and finally got a letter from Conseco--after jerking me around for weeks wanting more information—saying I was eligible for benefits as of October, 2008. So the agency that provides home care sent a nurse to our home at the beginning of October."

What Charles didn't know was that his policy with Conseco has a "90-day Elimination period" before the company starts long term care payments. " It is in the contract but the way it was worded threw a curve ball at me," says Charles. "I thought this meant a waiting period so I figured the 90 days would be up by October and I would be covered. My Conseco representative didn't tell me how it worked. In the contract it just says 'elimination period 90 days'.

I was under the impression that if you leave hospital and go into a nursing facility, Medicare has to pay those 90 days. According to the Conseco agent who sold me this policy, if you opt for home care, they won't pay a dime (which I found out after the fact). In other words, if I chose to send my wife to a nursing home, I wouldn't have had to pay anything. Instead I had to pay 90 days of care for my wife; I had to pay more than $5,000 out of my own pocket. I found out later that you can get a Conseco policy without this 90-day elimination period but it would cost you a fortune.

As well, I bought the policy in 2000 and the premiums keep going up. Now the premium is over $300 per month and it started at $215. Just a week ago Conseco asked for our power of attorney. That cost me another $200 plus change. When I try to call a representative, I always talk to someone different. These agents make you wait on the phone forever, then when you finally talk to someone they will never discuss your claim.

And talk about the time this has taken! They string you along for months, wanting one thing and then another. I have a stack of letters from Conseco; I had to give them a record of every call and letter the doctors and hospice made to me. They are piled up on my kitchen table—about ½ an inch thick, three month's worth of endless paperwork. Over the years since I filed, they have just asked for one thing after another and I am certain this is just a stall tactic to avoid paying our claim.

This so-called health insurance company has been sued before and no doubt they'll get sued again. Forty states and 40 attorneys general have filed suits against them and I can see why—it is no secret that this company has a blatant disregard for its clients.

I called our attorney general here in Missouri and they suggested I seek legal help. The state cannot do anything to help unless (or until) my claim is denied. I have been punished and put through the wringer by Conseco. I have been battling with these people and I want to get my money back, plus. It has been so frustrating and stressful, and I am not in good health either.

I would love to get my day in court because they shouldn't be able to do this. Taking care of someone 24/7 is not easy—why should we pay just because my wife stays at home rather than go to a nursing home? When this 90-day elimination period is over, I still don't know if they are going to make full payments—with their track record, I don't trust Conseco.

I believe the federal government should get it together and pass bills to have home care covered under Medicare so to avoid nursing homes. Wouldn't that save taxpayers a helluva lot of money?"