San Diego, CADeAnna is a caregiver and she also helped her client, an elderly woman, file her long term care insurance claim. If it wasn't for DeAnna, Conseco, a long term care health insurance company, may have gotten away with what amounts to robbery; they increased the woman's yearly policy from $2500 to $7000, and there's more…
"The insurance company also took months to pay," says DeaAnna. " I helped her file a claim and because it is ongoing, I had to fill out my hours of work every week and then send the form to Conseco. I started out working 4 hours a day but her doctor changed it to 8 hours. She needed daily care in order to stay in her home; luckily she has a niece who lives next door and weekends her daughter would come up so she had 24-hour care.
However, from September until January the insurance company only paid 4 hours, even though I sent the claim forms on time, stating I worked the full 8 hours. They gave us a really hard time to re-certify her claims. According to terms of the policy, family members were not paid. We finally got back pay, after all those months. I got so many different stories, I got shuffled from one department from another; I guess they will try anything to hang onto money.
And you have to keep accurate detailed records of everything, including conversations with them. It wouldn't hurt to have a tape recorder because every time you call, you talk to a different customer service rep and they give conflicting information. And you have to explain your situation from the beginning, each time. It is frustrating and time-consuming, to say the least.
I've learned that the one thing I hate is insurance companies—especially Conseco. When my client first purchased her policy in 1996, I guess the agent didn't explain things too well.
The most she can benefit is $100 per day, including all health care. She could have gotten a rider where the cost of living increases and it will pay more, but he didn't explain anything about that. There are a few riders involved that she knew nothing about and it would have cost her just a few dollars more. In 1996 the yearly policy cost her $2500 but by the time she filed the claim she was paying $7000 per year: Within a 10-year period it went up that much.
Nowhere in her policy did it say it would increase that much. It does say that they can only raise her long term care health insurance benefits if everyone else's policy in the state of California is raised. So the policy claims that everyone has to pay more? She definitely needs to get legal advice."