Interviews by The New York Times and confidential depositions indicate that some long-term-care insurers have developed procedures that make it nearly impossible for policyholders to be paid. A review of more than 400 of the thousands of grievances and lawsuits filed in recent years against the major long-term-care insurers shows elderly policyholders are confronting unnecessary delays and overwhelming bureaucracies.
Current and former employees at the companies Conseco, Bankers Life, and Penn Treaty have described business practices that denied or delayed policyholders' claims for seemingly trivial reasons. Employees said they had been prohibited from making phone calls to policyholders and that claims had been abandoned without informing policyholders.
"These tactics are becoming common throughout the industry," said George J. Kourpias, President of the Alliance. "Some of these companies coldheartedly calculate that older claimants will give up on being reimbursed."
Policyholders contend that Conseco, Bankers Life, and Penn Treaty denied claims because they failed to submit unimportant paperwork; because daily nursing notes did not detail minute procedures; because they filled out the wrong forms after receiving them from the insurance companies; and because facilities were deemed inappropriate even though they were licensed by state regulators.
Many lawsuits filed against long-term-care insurers have been settled with the requirement that settlement terms be kept confidential.
March 30, 2007
From today's issue of the ARA newsletter, comes another example of our dysfunctional healthcare system: