[Vision2020] NY Times: Aged, Frail and Denied Care by Their Insurers

[J Ford]

Crap!  The vote was a vote of confidence for Gritman's plan to help ALL of 
the community.  You might want to get your FACTS straight and leave off with 
the emotional throwing of stones.

You feel so strongly that you can provide better, why don't you get together 
with your family or friends and get something going instead of just spinning 
more discourse?

Thought so...........................


J  :]





>From: Donovan Arnold <donovanjarnold2005 at yahoo.com>
>To: Saundra Lund <sslund at roadrunner.com>, "'Pat Kraut'" 
><pkraut at moscow.com>,        "'vision2020'" <vision2020 at moscow.com>
>Subject: Re: [Vision2020] NY Times:  Aged,Frail and Denied Care by Their 
>Insurers
>Date: Mon, 26 Mar 2007 20:08:27 -0700 (PDT)
>
>Pat,
>
>   This fits Moscow well, since they just voted to kick out their indigent 
>elderly by shutting down the counties only facility for them.
>
>   Best,
>
>   Donovan
>
>
>
>
>
>Saundra Lund <sslund at roadrunner.com> wrote:
>   Just curious, Pat: what does your rant have to do with the article 
>posted &
>the issues raised by the article? Certainly the health care insurance
>crisis is nothing new, although it sickens me each time I read about it and
>look at the voting records of certain politicians (hint: the majority of
>the disgusting voting records with respect to health care and insurance
>aren't the voting records of Democrats).
>
>Isn't this just the kind of situation the Republicans want to let the 
>market
>-- supply & demand -- sort out???
>
>If not, then what's your solution? Clearly you think it's a problem since
>you mention insurance companies running amok, so how would you solve it
>given the climate the Big Business, which includes insurance companies, 
>must
>operate unfettered so that they can make their profits with no regard to 
>who
>they screw over in the process.
>
>Rather than ranting again about the Democrats and attacking public schools,
>how about doing something constructive like offering some solutions???
>
>
>Saundra Lund
>Moscow, ID
>
>The only thing necessary for the triumph of evil is for good people to do
>nothing.
>- Edmund Burke
>
>***** Original material contained herein is Copyright 2006 through life 
>plus
>70 years, Saundra Lund.  Do not copy, forward, excerpt, or reproduce 
>outside
>the Vision 2020 forum without the express written permission of the
>author.*****
>
>
>-----Original Message-----
>From: vision2020-bounces at moscow.com [mailto:vision2020-bounces at moscow.com]
>On Behalf Of Pat Kraut
>Sent: Monday, March 26, 2007 10:45 AM
>To: vision2020
>Subject: Re: [Vision2020] NY Times: Aged, Frail and Denied Care by Their
>Insurers
>
>While the dems dilly dally with who the AG is this country has some real
>problems...such as insurance run amok. The dems do not seem to realize the
>last vote was against the repubs not for dems and they are diminishing so
>much power from the office of the president it is dangerous. They and you
>may not like Bush but the next president is going to have to work within 
>the
>same protocol that they are trying to force on Bush. They really do not get
>what they are doing. And so many citizens of the US are so unaware of the
>truth of the Constitution that they do not understand. I blame the public
>school system because of the dumbing down of they classrooms.
>
>
>
>----- Original Message -----
>
>From: Art Deco
>To: Vision 2020
>Sent: Monday, March 26, 2007 6:51 AM
>Subject: [Vision2020] NY Times: Aged,Frail and Denied Care by Their
>Insurers
>
>The New York Times
>Printer Friendly Format
>Sponsored By
>m/printer-friendly&pos=Position1&camp=foxsearch2007-emailtools01d-nyt5-51127
>6&ad=animate2_namesake88x31.gif&goto=http://www.foxsearchlight.com/thenamesa
>ke/>
>
>
>________________________________
>
>March 26, 2007
>
>Aged, Frail and Denied Care by Their Insurers
>
>By CHARLES DUHIGG
>/index.html?inline=nyt-per>
>
>CONRAD, Mont. — Mary Rose Derks was a 65-year-old widow in 1990,
>when she began preparing for the day she could no longer care for herself.
>Every month, out of her grocery fund, she scrimped together about $100 for
>an insurance policy that promised to pay eventually for a room in an
>assisted living home.
>
>On a May afternoon in 2002, after bouts of hypertension
>/bloodpressure/index.html?inline=nyt-classifier> and diabetes
>/diabetes/index.html?inline=nyt-classifier> had hospitalized her dozens of
>times, Mrs. Derks reluctantly agreed that it was time. She shed a few 
>tears,
>watched her family pack her favorite blankets and rode to Beehive Homes,
>five blocks from her daughter’s farm equipment dealership.
>
>At least, Mrs. Derks said at the time, she would not be a financial
>burden on her family.
>
>But when she filed a claim with her insurer, Conseco
>/custom/nyt-com/html-companyprofile.asp&symb=CNOPRB;CNOWS> , it said she 
>had
>waited too long. Then it said Beehive Homes was not an approved facility,
>despite its state license. Eventually, Conseco argued that Mrs. Derks was
>not sufficiently infirm, despite her early-stage dementia and the 37 pills
>she takes each day.
>
>After more than four years, Mrs. Derks, now 81, has yet to receive a
>penny from Conseco, while her family has paid about $70,000. Her daughter
>has sent Conseco dozens of bulky envelopes and spent hours on the phone.
>Each time the answer is the same: Denied.
>
>Tens of thousands of elderly Americans have received life-prolonging
>care as a result of their long-term-care policies. With more than eight
>million customers, such insurance is one of the many products that 
>companies
>are pitching to older Americans reaching retirement.
>
>Yet thousands of policyholders say they have received only excuses
>about why insurers will not pay. Interviews by The New York Times
>/custom/nyt-com/html-companyprofile.asp&symb=> and confidential depositions
>indicate that some long-term-care insurers have developed procedures that
>make it difficult — if not impossible — for policyholders to get paid. A
>review of more than 400 of the thousands of grievances and lawsuits filed 
>in
>recent years shows elderly policyholders confronting unnecessary delays and
>overwhelming bureaucracies. In California alone, nearly one in every four
>long-term-care claims was denied in 2005, according to the state.
>
>“The bottom line is that insurance companies make money when they
>don’t pay claims,” said Mary Beth Senkewicz, who resigned last year as a
>senior executive at the National Association of Insurance Commissioners.
>“They’ll do anything to avoid paying, because if they wait long enough, 
>they
>know the policyholders will die.”
>
>In 2003, a subsidiary of Conseco, Bankers Life and Casualty, sent an
>85-year-old woman suffering from dementia the wrong form to fill out,
>according to a lawsuit, then denied her claim because of improper 
>paperwork.
>Last year, according to another pending suit, the insurer Penn Treaty
>American
>/custom/nyt-com/html-companyprofile.asp&symb=PTA> decided that a
>92-year-old man had so improved that he should leave his nursing home
>despite his forgetfulness, anxiety and doctor’s orders to seek continued
>care. Another suit contended that a company owned by the John Hancock
>Insurance Company had tried to rescind the coverage of a 72-year-old man
>when he was diagnosed with Alzheimer’s
>/alzheimers/index.html?inline=nyt-classifier> disease four years after
>buying the policy.
>
>In court filings, all three companies said the denials had been
>proper. They declined further comment on the cases, though Bankers Life and
>John Hancock eventually settled for unspecified amounts.
>
>In general, insurers say criticisms of claims-handling are unfair
>because most policyholders are paid promptly and some denials are necessary
>to root out fraud.
>
>In a statement, Conseco said the company “is committed to the
>highest standards for ethics, fairness and accountability, and strives to
>pay all claims in accordance with policy contracts.” Penn Treaty said in a
>statement, “We strive to treat all policyholders fairly, and to deliver the
>best, most efficient evaluation of their claim as possible.”
>
>But policyholders have lodged thousands of complaints against the
>major long-term-care insurers. A disproportionate number have focused on
>Conseco, its affiliate, Bankers Life, and Penn Treaty. 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. (The complaints touch on a variety of
>topics, including claims handling, price increases and advertising 
>methods.)
>
>By comparison, Genworth Financial
>/custom/nyt-com/html-companyprofile.asp&symb=GNWPRE> , the largest
>long-term-care insurer, received only one complaint for every 12,434
>policies.
>
>Conseco is among the nation’s largest insurers, collecting premiums
>worth more than $4.2 billion in 2006, of which long-term-care policies
>contributed 21 percent. Penn Treaty focuses primarily on long-term-care
>products and collected premiums of about $320 million in 2004, the last 
>year
>the company filed an audited annual report.
>
>In depositions and interviews, current and former employees at
>Conseco, Bankers Life and Penn Treaty 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. Such tactics, advocates for the elderly say, are becoming
>common throughout the industry.
>
>“These companies have essentially turned their bureaucracies into
>profit centers,” said Glenn R. Kantor, a California lawyer who has
>represented policyholders.
>
>Yet these concerns have been ignored by state regulators, advocates
>say, and have gone unnoticed by federal lawmakers who recently passed
>incentives intended to promote purchases of long-term-care policies, in the
>hopes of forestalling a Medicare funding crisis.
>
>Conseco and Bankers Life “made it so hard to make a claim that
>people either died or gave up,” said Betty J. Hobel, a former Bankers Life
>agent in Cedar Rapids, Iowa.
>
>“When someone is 70 or 80 years old,” she said, “how many times are
>they going to try before they just give up?”
>
>A Race to Sell Policies
>
>When Mrs. Derks bought her long-term-care policy from a door-to-door
>salesman in 1990, she was unaware that she represented the insurance
>industry’s newest gold mine.
>
>Her husband had died eight years earlier of a stroke, leaving her to
>run a barley farm in northern Montana, where she lived with her three
>children and her aging mother. As she watched her own parent decline, Mrs.
>Derks became preoccupied with sparing her children the expense of her final
>years.
>
>“She was terrified that she would bankrupt us or get sent to a
>public nursing home,” said Ken E. Wheeler, her son-in-law.
>
>At the time, long-term-care policies, which can cover the costs of
>assisted-living facilities, nursing homes and at-home care, were becoming
>one of the insurance industry’s fastest-growing products. Companies like
>Conseco, Bankers Life and Penn Treaty were aggressively signing up clients
>who were not in the best health at rates far below their competitors’ in
>order to win more business, former agents said. From 1991 to 1999,
>long-term-care sales helped drive total revenue gains of roughly 500 
>percent
>each at Penn Treaty and Conseco, including its affiliate Bankers Life.
>
>Cracks in the business, however, soon started to appear. Insurance
>executives began warning they had underestimated how long policyholders
>would live after entering nursing homes. The costs of treating Alzheimer’s,
>Parkinson’s
>/parkinsonsdisease/index.html?inline=nyt-classifier> and diabetes
>ballooned.
>
>As insurers began realizing their miscalculations, they persuaded
>insurance commissioners in California, Pennsylvania, Florida and other
>states to approve price increases of as much as 40 percent a year.
>
>By 2002, Conseco’s long-term-care payouts exceeded revenue. Those
>and other disappointing results prompted the company to file for 
>bankruptcy,
>from which it emerged 10 months later.
>
>That same year, Mrs. Derks entered Beehive Homes, a cheery, 12-bed
>center one block from the Prairie View elementary school. In the previous
>four years, she had been hospitalized more than two dozen times. She had
>once lain unconscious in her living room for a day and a half. Her 
>physician
>ordered her into an assisted-living center.
>
>Initially, Conseco told Mrs. Derks’s daughter, Jackie Wheeler, that
>her claim would go through smoothly, Mrs. Wheeler said. The family began
>paying Beehive Homes’s $1,900 monthly fee.
>
>But three months after submitting her claim, Mrs. Derks received a
>letter from Conseco saying she had waited too long, and her earliest costs
>would not be reimbursed. Two months later, she received another letter
>denying her entire claim because she had not submitted proof of illness.
>
>Yet a copy of Mrs. Derks’s policy, sent to the Wheelers by Conseco
>in 2004 and reviewed by The Times, mentions no requirement for proof of
>illness. The policy requires only that the confinement be ordered by a
>physician, and it allows for a notice of claim to be sent “as soon as
>reasonably possible.”
>
>Mrs. Derks’s daughter called Conseco and explained that her mother
>could not recall the date or people’s names and had started multiple fires
>by forgetting to turn off the stove. She sent letters stating that her
>mother needed assistance to dress, eat, go to the bathroom and inject
>insulin.
>
>“This is medically necessary!!!” reads a form signed by Mrs. Derks’s
>physician in 2004. “This has been filled out three times! This person needs
>assistance!”
>
>Seven months later, Conseco sent another letter, this time denying
>Mrs. Derks’s claim because her policy “requires a staffed registered nurse
>24 hours per day.” Her policy does not mention such a requirement.
>
>Conseco also sent letters denying Mrs. Derks’s claim because her
>policy had an “assisted living facility rider,” and because Mrs. Derks 
>“does
>not have an assisted living facility rider.” In all, the family received
>more than a dozen letters from the company. Many contradict one another, 
>and
>frequently cite requirements that are nowhere mentioned in Mrs. Derks’s
>policy.
>
>“There was always a new step in the runaround,” Mrs. Wheeler said.
>“It felt like everything was designed to make me just go away.”
>
>Over two years, Mrs. Wheeler estimated, she called the company about
>100 times. Twice a month, she sent envelopes stuffed with medical records.
>Some afternoons, she spent hours making calls. After one conversation, Mrs.
>Wheeler slammed down the phone and started to cry. Then she drove to 
>Beehive
>Homes, where her mother was surrounded by faded photos of her childhood and
>boxes of adult diapers.
>
>“I wouldn’t tell her about the problems we were having with Conseco,
>because I knew it would cause her so much worry,” Mrs. Wheeler said.
>
>Eventually, the Wheelers sold part of their John Deere dealership to
>raise money to pay for her mother’s care. In October 2006, they sued.
>
>Conseco, asked by a reporter about the company’s handling of the
>Derks claim, declined to answer, citing the pending litigation. In court
>documents, the company denied Mrs. Derks’s allegations without specifying
>why her claim was denied.
>
>“We did everything they asked,” Mrs. Wheeler said. “And this company
>just treats us like dirt.”
>
>Tales of Bureaucracy
>
>Inside the large Conseco headquarters in Carmel, Ind., scores of
>employees receive the flood of documents and calls that arrive each day. At
>times, according to depositions and interviews, that deluge became so
>overwhelming that documents were lost, calls went unreturned and mistakes
>occurred.
>
>Some employees describe vast mailrooms where documents appear and
>disappear. One call-center representative said he was afforded an average 
>of
>only four minutes to handle each policyholder’s call, no matter how
>complicated the questions. Employees said they were instructed not to say
>when the company was behind in processing paperwork, even when the backlog
>extended to 45 days. Workers were prohibited from contacting each other by
>phone, although such calls might have quickly resolved obstacles, according
>to depositions.
>
>Conseco, asked in detail about the company’s policies, declined to
>respond.
>
>Bureaucratic obstacles were pervasive, according to interviews with
>10 former Conseco employees and depositions of more than a dozen others.
>Robert W. Ragle, a former Bankers Life branch manager, once contacted the
>claims department on behalf of a client, and “they just laughed us off the
>phone,” he said. “Their mentality is to keep every dollar they can.” Mr.
>Ragle was dismissed by Bankers Life in 2002. He sued for wrongful
>termination and settled out of court.
>
>In lawsuits, complaints and interviews, policyholders contend that
>Conseco, Bankers Life or Penn Treaty denied claims because policyholders
>failed to submit unimportant paperwork; because daily nursing notes did not
>detail minute procedures; because policyholders 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.
>
>In depositions conducted on behalf of angry policyholders, Conseco
>employees described bureaucratic obstacles that prevented payment of 
>claims.
>Those depositions were sealed in settlement agreements but were obtained by
>The Times.
>
>In a 2006 deposition, a Bankers Life and Conseco claims adjuster,
>Teresa Carbonel, testified that she denied claims because of missing 
>records
>but was prohibited from calling nursing homes or physicians to request the
>documents. She also testified that when a claim was denied, she was
>forbidden to phone a policyholder, but instead used a time-consuming 
>mailing
>system.
>
>Ms. Carbonel’s testimony, recorded during lawsuit on behalf of a
>94-year-old policyholder, Rhodes K. Scherer, also disclosed that if
>policyholders did not mail requested documents within 21 days, Conseco 
>might
>abandon their claim, sometimes without informing them.
>
>In the case of Mr. Scherer, who was institutionalized after a
>bathroom fall, it was difficult to obtain a response, Ms. Carbonel said,
>because the company’s requests were mailed to his home address, rather than
>the nursing center where the company had been notified that he had moved.
>Ms. Carbonel, who is no longer with the company, did not return calls.
>Conseco declined to comment on her testimony.
>
>In another deposition, Conseco’s then-senior manager for long-term-
>care claims, Jose S. Torres, testified that Conseco would sometimes 
>withhold
>payments until it received documents not required by customers’ policies. 
>In
>Mr. Scherer’s case, Mr. Torres said, the company refused to pay his nursing
>home costs unless he sent copies of the home’s license, payment invoices 
>and
>medical records, even though those documents had no bearing on approving 
>his
>claim.
>
>Mr. Scherer’s claim “was handled not in the best way, but it was
>handled according to the processes and procedures placed at the time,” Mr.
>Torres testified. “Mistakes are going to be made, you know.”
>
>Other executives testified that when Conseco appeared to have lost
>important documents in Mr. Scherer’s claim, no investigation was initiated.
>Shawn Michael Schechter, a Conseco claims supervisor who left the company 
>in
>2005 on positive terms, according to the deposition, testified that the
>handling of Mr. Scherer’s claim violated the principle of good faith, which
>requires insurance companies to treat customers fairly.
>
>“The claim adjuster could have made that very easy and not have put
>the burden back onto the policyholder,” he testified.
>
>Mr. Torres did not return calls. Mr. Schechter declined to answer
>questions.
>
>Mr. Scherer died in 2004 without receiving benefits from Conseco.
>His estate settled with the company in February for an undisclosed amount,
>according to a lawyer representing the estate.
>
>Conseco declined to discuss its complaint history or individual
>cases, citing confidentiality agreements. In its statement, the company 
>said
>that in 2006, Conseco paid nearly $2.3 billion on 9.8 million claims in all
>
>=== message truncated ===
>
>
>---------------------------------
>8:00? 8:25? 8:40?  Find a flick in no time
>  with theYahoo! Search movie showtime shortcut.


>=======================================================
>  List services made available by First Step Internet,
>  serving the communities of the Palouse since 1994.
>                http://www.fsr.net
>           mailto:Vision2020 at moscow.com
>=======================================================

_________________________________________________________________
It’s tax season, make sure to follow these few simple tips 
http://articles.moneycentral.msn.com/Taxes/PreparationTips/PreparationTips.aspx?icid=HMMartagline