Mothers Denied Long Term Care Insurance

Sacramento, CAPeople rely on long term care insurance to provide help if and when they are unable to help themselves. Policy holders are entitled to have the costs of assisted living, managed care or home health paid for by their health insurance company if they suffer from serious and chronic physical or mental illness, disability or impairment. Yet many of our elderly population are increasingly denied coverage, often due to outdated policies, and insurance bad faith practices seem to be the norm for some insurance companies such as Conseco, its affiliate, Bankers Life, and Penn Treaty.

And long-term care insurance isn't of course just for the elderly. It is supposed to pay for at-home care, assisted living or nursing-home care, regardless of age. However, delays, premium increases and denials of payment make the enormous investment in long-term care polices all too often worthless.

Insurance companies have many tactics to deny policyholders a valid claim, from lengthy delays and partial payments to flat-out denials. There are more than 8 million people in the US holding long term care policies, making it a very lucrative business. And the more claims denied mean bigger profits for the insurance companies.

Countless grievances are filed every year and, according to the state of California alone, nearly one in every four long-term-care claims was denied in 2005. Last March, 2007 the New York Times reported that in 2005, Conseco received more than one complaint regarding long-term-care insurance for every 383 such policyholders, according to data from the insurance commissioners' association. Penn Treaty received one complaint for every 1,207 long-term-care policyholders.

Many people are worried, wondering whether their parents will be able to afford long-term nursing care, despite having a policy that has cost them thousands and thousands of dollars. And many find the task of sorting out long-term care policies overwhelming; often they don't even know if their parents qualify for assisted living.

Helen says Conseco long Term Care refuses to pay for her mother's care, even though she paid premiums for 15 years and now suffers from Amyotrophic lateral sclerosis (ALS), also known as "Lou Gehrig's Disease.

"My parents paid for a policy that was eventually bought by Conseco," says Helen. "My mother was diagnosed with ALS a little over a year ago and six months later we decided that we could no longer care for her without help. We contacted and interviewed agencies that the local Visiting Nurse Association (VNA) suggested. Then we submitted all the proper documents and allowed Conseco's nurse to interview my mother and determine whether the care at the agencies we chose would be appropriate.

The nurse filed her report stating that we could only have 8 hours of care daily, but our doctor says that my mother needs 24-hour care and the policy allows for 24 hour care. Now, 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 Medicare picks up some of the tab; that way their obligation to her, regardless of the premiums she paid, is lessened."

Steve writes that Conseco refuses to pay his mother's assisted living cost after she paid a premium for 20 years. "The health insurance company keeps asking for information I have already provided and then they want the most trivial information," he says. "Basically they are stalling by continuing to ask for information they already have or do not need—my mother has been in a rest home for three months now and I am paying out of my own pocket."

There is a glimmer of hope on the horizon: the laws have recently changed, creating stricter checks and controls on the insurance company's practices. And lawsuits are successfully settled against insurance companies such as Conseco. If your long term care insurance company is practicing bad faith, you may want to seek legal help.