Long-Term Care Ins. Co's avoid paying
People are beginning "to get it": The incidence of Alzheimer's disease will increase three-fold. In addition, the relative number of potential caregivers will decline by about three. Anticipating the huge burden on their families, many are buying long-term-care insurance. It seems a reasonable alternative to going bankrupt, or to using a facility (if one will actually be available by that time) that Medicaid (MediCal) would pay for after they almost go bankrupt.
Now for the bad news, as reported By Charles Duhigg in the New York Times on March 26, 2007. (The specific link to The Times is given at the end of this article.)
According to The Times, some insurances companies have sold policies and taken the insured’s premiums for years, and then, when the patients became qualified to receive the benefits they had paid for, gave them a bureaucratic run around designed to frustrate them until they either died or gave up. For the “aged and frail,” especially those who have no one else to fight for them, giving up or dying are likely outcomes. Even those with younger adult children doing the fighting have had to sell family assets in the meantime, while the tactics were being played. (See the Times article for specific stories.)
The Times interviewed former employees of insurance companies who revealed such strategies as mailing beneficiaries the wrong forms to the wrong addresses... and then after a long delay, they denied the claim since the policy holder either filled out the wrong form or waited too long to respond. Other reasons to deny claims included the irrelevant fact that facility was not approved; the patient was “not sufficiently infirm” despite a doctor’s orders; or the policy conditions were not met. The Times noted that many times, these conditions were not mentioned in the original contract.
Of course, not all insurance companies are guilty. But with the number of claims undoubtedly destined to rise dramatically over the next few decades, one should purchase long-term-care policies prudently. One company had one complaint for every 383 policy holders compared to another company which had only one in over 12 thousand. The New York Times article stated, “In California alone, nearly one in every four long-term-care claims was denied in 2005.” The Times quoted Glenn R. Kantor, a California lawyer who has represented policyholders, as saying, “These companies have essentially turned their bureaucracies into profit centers.” Alleging restrictions on insurance company employees from making phone calls to expedite requests for missing records, and other tactics, one could say that their motto seems to be, “To delay is to increase profits.”
Click here for the complete article, entitled, “Aged, Frail and Denied Care by Their Insurers”.
Now for the bad news, as reported By Charles Duhigg in the New York Times on March 26, 2007. (The specific link to The Times is given at the end of this article.)
According to The Times, some insurances companies have sold policies and taken the insured’s premiums for years, and then, when the patients became qualified to receive the benefits they had paid for, gave them a bureaucratic run around designed to frustrate them until they either died or gave up. For the “aged and frail,” especially those who have no one else to fight for them, giving up or dying are likely outcomes. Even those with younger adult children doing the fighting have had to sell family assets in the meantime, while the tactics were being played. (See the Times article for specific stories.)
The Times interviewed former employees of insurance companies who revealed such strategies as mailing beneficiaries the wrong forms to the wrong addresses... and then after a long delay, they denied the claim since the policy holder either filled out the wrong form or waited too long to respond. Other reasons to deny claims included the irrelevant fact that facility was not approved; the patient was “not sufficiently infirm” despite a doctor’s orders; or the policy conditions were not met. The Times noted that many times, these conditions were not mentioned in the original contract.
Of course, not all insurance companies are guilty. But with the number of claims undoubtedly destined to rise dramatically over the next few decades, one should purchase long-term-care policies prudently. One company had one complaint for every 383 policy holders compared to another company which had only one in over 12 thousand. The New York Times article stated, “In California alone, nearly one in every four long-term-care claims was denied in 2005.” The Times quoted Glenn R. Kantor, a California lawyer who has represented policyholders, as saying, “These companies have essentially turned their bureaucracies into profit centers.” Alleging restrictions on insurance company employees from making phone calls to expedite requests for missing records, and other tactics, one could say that their motto seems to be, “To delay is to increase profits.”
Click here for the complete article, entitled, “Aged, Frail and Denied Care by Their Insurers”.
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