[Vision2020] NY Times: Aged,
debismith at moscow.com
debismith at moscow.com
Mon Mar 26 10:50:23 PDT 2007
Indeed---I, like Pat, blame everything on the "dumbing down of they
classrooms"----damn guvmint schools. They is jes not teeching peepole how
to rite....
Seriously, I find it ironic that
1. those who cannot string together a coherent sentence insist on
lecturing others about the failure of our educational system,
2. who repeatedly fail to remove their ideological blinders enough to
recognize the Bush administration's erosion of constitutional rights feel
they must lecture more thoughtful people on the Constitution and
3. who continue to blithely support anything resembling a far right-
wingnut view must chastise anyone/everyone else for having an agenda....
Oh, well, at least they are consistent, if not the brightest crayons in
the box.
Debi R-S
> "While the dems dilly dally..." Doggone dose dastardly dilly dallying
> dems. Not to mention an increasing number of regrettably reprobate
repubs?
> Carl Westberg Jr.
>
>
> >From: "Pat Kraut" <pkraut at moscow.com>
> >To: "vision2020" <vision2020 at moscow.com>
> >Subject: Re: [Vision2020] NY Times: Aged,Frail and Denied Care by
Their
> >Insurers
> >Date: Mon, 26 Mar 2007 09:45:01 -0800
> >
> >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
> >
> >
> >
> >
> >
> >
> >-----------------------------------------------------------------------
-------
> >
> > March 26, 2007
> > Aged, Frail and Denied Care by Their Insurers
> > By CHARLES DUHIGG
> > 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 and
diabetes 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, 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 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 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
> >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, 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 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
> >types of insurance sold by the company.
> >
> > The company added: "Conseco, through training, education and
process
> >improvements in all of its insurance companies, is continuously
focused on
> >enhancing service and resolving any problems expeditiously. The
Conseco
> >Insurance Group's overall insurance department complaints decreased 20
> >percent from 2005 to 2006."
> >
> > Depositions of executives at Penn Treaty also point to questionable
> >practices. In a 2005 lawsuit, a Penn Treaty senior vice president,
Stephen
> >Robert LaPierre, testified that the company rejected one claim without
> >informing the policyholder why, asked for information that was not
required
> >to process a claim, gave incomplete information about a claim's status
and
> >said the company was delaying payment because of an investigation
while
> >failing to take steps that might have resolved the inquiry.
> >
> > Mr. LaPierre declined to discuss his testimony. Penn Treaty settled
the
> >lawsuit by paying the policyholder an unspecified amount, the
> >policyholder's lawyer said.
> >
> > Penn Treaty said in a statement that evaluating a company by
measuring
> >its complaints was flawed, and that since 2003, the company has denied
an
> >average of less than 1.7 percent of the up to 8,000 claims it received
> >every year because of reasons related to policyholder
eligibility. "From
> >time to time, Penn Treaty is compelled to investigate fraud or
questionable
> >billing activities," the company added.
> >
> > Few Regulatory Inquiries
> >
> > Few of the cases or complaints filed against Conseco, Bankers Life,
Penn
> >Treaty or other insurers have received much attention, in part because
many
> >lawsuits filed against long-term-care insurers have been settled with
the
> >requirement that depositions, documents and settlement terms be kept
> >confidential. Frequently, say policyholders' lawyers, the companies
have
> >been willing to pay millions of dollars in exchange for
confidentiality.
> >
> > Furthermore, despite the complaints against long-term-care
insurers, few
> >states have conducted meaningful investigations.
> >
> > Ron Gallagher, a deputy commissioner with the Pennsylvania
Insurance
> >Department, said, "I don't know that we have a real problem with
improper
> >claim denials."
> >
> > Yet data from the National Association of Insurance Commissioners
show
> >that from 2003 to 2005, Pennsylvania received more complaints
regarding
> >Conseco, Bankers Life and Penn Treaty than any other state. Mr.
Gallagher
> >said he might begin a new review of those companies.
> >
> > Other states with large numbers of long-term-care complaints,
including
> >California, Missouri, Maryland, Indiana and Washington have not begun
> >investigations, or have reviewed only small numbers of policies.
> >
> > As a result, other seniors may end up like Mrs. Derks.
> >
> > While she was waiting for her lawsuit to proceed, Medicaid began
> >contributing to Ms. Derks's care. Taxpayers now pay Beehive Homes
about $32
> >daily for her care.
> >
> > "Long-term-care insurance is supposed to result in less pressure on
> >Medicaid, not more," said Ms. Senkewicz, the former executive at the
> >insurance commissioners' association.
> >
> > For Mrs. Derks's family, things have already broken down.
> >
> > "How many other people are out there who don't have a family to
fight
> >for them and have just given up?" asked Jackie Wheeler. "This company
> >should be ashamed."
> >
> >
> >
> >-----------------------------------------------------------------------
-------
> >
> >
> > =======================================================
> > 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
> > =======================================================
> >
> >
> >-----------------------------------------------------------------------
-------
> >
> >
> > No virus found in this incoming message.
> > Checked by AVG Free Edition.
> > Version: 7.5.446 / Virus Database: 268.18.18/733 - Release Date:
3/25/07
> >11:07 AM
> ><< logoprinter.gif >>
> ><< spacer.gif >>
> ><< printerfriendly.gif >>
> ><< animate2_namesake88x31.gif >>
>
>
> >=======================================================
> > 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
> >=======================================================
>
> _________________________________________________________________
> Get a FREE Web site, company branded e-mail and more from Microsoft
Office
> Live! http://clk.atdmt.com/MRT/go/mcrssaub0050001411mrt/direct/01/
>
> =======================================================
> 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
> =======================================================
>
---------------------------------------------
This message was sent by First Step Internet.
http://www.fsr.com/
More information about the Vision2020
mailing list