Paul (not his real name pending a lawsuit) says his parents bought an in-home healthcare policy from a company that went belly-up and Conseco took over, creating another company called Washington National. "From my perspective it is a front to insulate Conseco from liability—if you have a lawsuit against Conseco, they would simply hide behind this other company," Paul explains."According to my lawyer, Conseco is going to try and establish a trust fund that will take care of all existing long term health care policies: they will put money into this fund, let the trust fund pay out their existing policies and in so doing, they insulate themselves yet again.," he says. "They are putting several billion dollars into this, then wiping their hands of all long term care policies because the trust fund will eventually run out of money; their excuse will likely be that costs were too high…
My parents both have a 5-year in-home health care policy--take 5 years and multiply by $200 per day and that is the maximum amount Conseco will pay, per person. Herein lies the problem: When my parents first started making claims, the nurse care agency was paid inconsistently by Conseco. The way these policies work is that you must be evaluated for approval by a nurse—they call it the ADL (activities for daily living) test. My parents were approved and the next step was finding an agency that met Conseco's approval. In turn, that agency, separate from Conseco, found my parents a company that would provide nurses to their home. Everything was supposed to be honky dory and we would pay the extra costs—over and above $200 per day for each parent. As far as we were concerned, it was a done deal.
This is how I got involved: Most people want to stay at home as long as possible with some semblance of independence and this is just what my parents wanted. In 2005 my mother was 85 and my father was 87--people that age aren't able to track things very well so I have been handling their finances. And this is what I discovered…
The nurse care agency billed Conseco but the nurses would be reimbursed erratically for legitimate claims. On one particular day 2 nurses came in--one for 4 hours and the other for 2 hours. The second nurse submitted her time card a week later and Conseco wouldn't recognize it—they refused to pay the bill. Unfortunately the agency can't track what Conseco is paying the nurses. So how does that affect my parents? The nursing agency says we have to pay them or they won't supply nurses.
As of today, The nurse care agency has billed my parents a total of $60,000—the balance they say we and Conseco owe. But the bottom line is that Conseco owes about half and we owe the other half. Now the agency is telling us that we need to make a payment or my parents won't receive further care.
I am dealing with the agency but what if they call my parents? My father is an angry, emotional wreck and my mother has Alzheimer's disease; how can she look after my father? We understand that we owe a large chunk of this bill but we don't know the total because Conseco was erratic in their payments.
Since 2005 the nursing agency has sent two detailed accountings to Conseco complete with spread sheets. The agency nurses contacted me in the fall of 2007 and asked for some kind of payment. I paid the agency $35,000 and now I am angry. As of February 2008 I started counting everything billed to Conseco from the agency and everything Conseco paid out—to the dime.
In a particular 2-week period, I found 7 days of long term nursing care, legitimate and approved, underpaid. Since I noticed that incident-- which was 8 months ago-- I have made numerous phone calls to Conseco customer service and documented them all. I have submitted documents in writing, and I told Conseco that I am going to sue them. What do you suppose they did?
Nothing.
Well, not quite nothing. They took a random 2-week period, then did a 3 -day review and said the nurses were paid. (Of course there are many other incidents and issues besides this one time period.) I documented everything for that 2-week period and presented it to my lawyer--with this information he agreed to take on my case. My lawyer suggested that I figure out my objectives and what I wanted out of this lawsuit. Taking his advice, I did just that and sent it to Conseco.
This is what I sent: I asked Conseco to give me a detailed account of benefits paid by individual date of service—they told me that information is not available, which is crazy. That information is an industry standard.
I wanted the ability to talk to a claims representative directly instead of speaking to a customer service rep--the bottom line for a run-around. Thirdly, I wanted a specific case manager assigned so when I call, I will speak with someone who knows this case. And that is called accountability. Again I was told NO Way!
Eventually, I spoke with one empathetic woman at Conseco and I asked, almost pleaded for her extension number so I could deal with her in the future. She couldn't give me her number but absolutely promised to call back. Guess what? She disappeared into the ether…that was the straw that broke the camel's back. When she said I could depend on her and didn't call me back, I called a lawyer. I can't resolve this problem by myself.
READ MORE LONG TERM CARE INSURANCE LEGAL NEWS
In May, 2008 Conseco paid a $2.35 million fine to insurance regulators of 5 states—they got caught. They didn't admit guilt but paid the fine with a promise of fixing their system within the next 2 or 3 years or pay an additional $10 million fine. That is chump change to them. There is absolutely no transparency in this company and they also stonewalled the regulators.
Conseco has to be held accountable."