Kingsbury, TXMelinda's 95-year-old mother was denied long term care health insurance because she could remember her name, therefore she was not 'cognitively impaired', which is one stipulation that Conseco life insurance says is necessary to qualify for long term care insurance in an assisted living facility. It was irrelevant that her mother couldn't walk unassisted or that she couldn't take her meds by herself.
Melinda and her siblings took their Mum to Beehive, a small assisted living center, after she fell and broke a vertebrae. "Mum was there from June until November last year, but then we found out that Conseco life insurance refused to pay based upon their qualifications for daily living," she says. "It was very expensive for us: The assisted living fee was $1900 per month and we also paid the premium to Conseco—$660 per month.
"When we took Mum to Beehive, we simply assumed that her health insurance policy would cover the costs. ' Does your mother know her name?' asked the service rep at Conseco. 'Of course she does,' I told her, otherwise Mum would be in a nursing home. She had been seen by a psychiatrist because the insurance company told us that was a stipulation; he said she qualified for assisted living. Still, Conseco denied her long term insurance!
In November, Mum went into hospital and when she was released we took her home instead of taking her back to Beehive; we realized that she wouldn't manage at the assisted living facility. She couldn't walk on her own and she was very confused—morphine can do a number on the elderly.
While she was home, we watched her very carefully; we didn't know what to do. But then she fell again and fractured her rib so we knew she had to go into a nursing home. We had a difficult time finding a vacancy but eventually found a room for her in January of 2008.
I phoned Conseco and asked what kind of forms needed to be completed—new forms had to be filled out. She still had to pay premiums for another 90 days that she was in the nursing home—as stated in her policy. Mum had a 90-day elimination period and a 180-day waiver of premium (which means she had to continue to pay her premium for 180 days).
Finally Conseco made payments after 90 days; I kept calling and asking when the 180 days was up. They still hadn't sent the letter to their waver department! 'Can you imagine what kind of stress and strain this puts on families?' I said to the rep. She couldn't care less. I did get a refund eventually, but it was infuriating. I was hoping not to pay after 180 days but they don't care if you are inconvenienced.
I can't believe the tricks they play to get out of paying long term care health insurance. I know the assisted living facility would not work for her now, but during those 6 months at Beehive, Conseco decided that they would not pay for assisted living, even though the psychiatrist said she shouldn't have any problems getting assistance.
You ask someone at Conseco a question and they never give you a straight answer, they won't even give you their last name. They are difficult to deal with and I think that is part of their training--to be as vague and nasty as possible but stay within the rules. And for some people who are denied health insurance, they don't even play by the rules."