<div>Pat,</div> <div> </div> <div>This fits Moscow well, since they just voted to kick out their indigent elderly by shutting down the counties only facility for them.</div> <div> </div> <div>Best,</div> <div> </div> <div>Donovan</div> <div> </div> <div> </div> <div> </div> <div><BR><BR><B><I>Saundra Lund <sslund@roadrunner.com></I></B> wrote:</div> <BLOCKQUOTE class=replbq style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">Just curious, Pat: what does your rant have to do with the article posted &<BR>the issues raised by the article? Certainly the health care insurance<BR>crisis is nothing new, although it sickens me each time I read about it and<BR>look at the voting records of certain politicians (hint: the majority of<BR>the disgusting voting records with respect to health care and insurance<BR>aren't the voting records of Democrats).<BR><BR>Isn't this just the kind of situation the Republicans
want to let the market<BR>-- supply & demand -- sort out??? <BR><BR>If not, then what's your solution? Clearly you think it's a problem since<BR>you mention insurance companies running amok, so how would you solve it<BR>given the climate the Big Business, which includes insurance companies, must<BR>operate unfettered so that they can make their profits with no regard to who<BR>they screw over in the process.<BR><BR>Rather than ranting again about the Democrats and attacking public schools,<BR>how about doing something constructive like offering some solutions???<BR><BR><BR>Saundra Lund<BR>Moscow, ID<BR><BR>The only thing necessary for the triumph of evil is for good people to do<BR>nothing.<BR>- Edmund Burke<BR><BR>***** Original material contained herein is Copyright 2006 through life plus<BR>70 years, Saundra Lund. Do not copy, forward, excerpt, or reproduce outside<BR>the Vision 2020 forum without the express written permission of
the<BR>author.*****<BR><BR><BR>-----Original Message-----<BR>From: vision2020-bounces@moscow.com [mailto:vision2020-bounces@moscow.com]<BR>On Behalf Of Pat Kraut<BR>Sent: Monday, March 26, 2007 10:45 AM<BR>To: vision2020<BR>Subject: Re: [Vision2020] NY Times: Aged, Frail and Denied Care by Their<BR>Insurers<BR><BR>While the dems dilly dally with who the AG is this country has some real<BR>problems...such as insurance run amok. The dems do not seem to realize the<BR>last vote was against the repubs not for dems and they are diminishing so<BR>much power from the office of the president it is dangerous. They and you<BR>may not like Bush but the next president is going to have to work within the<BR>same protocol that they are trying to force on Bush. They really do not get<BR>what they are doing. And so many citizens of the US are so unaware of the<BR>truth of the Constitution that they do not understand. I blame the public<BR>school system because of the dumbing down of they
classrooms. <BR><BR><BR><BR>----- Original Message ----- <BR><BR>From: Art Deco <mailto:deco@moscow.com><BR>To: Vision 2020 <mailto:vision2020@moscow.com><BR>Sent: Monday, March 26, 2007 6:51 AM<BR>Subject: [Vision2020] NY Times: Aged,Frail and Denied Care by Their<BR>Insurers<BR><BR>The New York Times <HTTP: www.nytimes.com /><BR><HTTP: spacer.gif ads graphics8.nytimes.com>Printer Friendly Format<BR>Sponsored By<BR><HTTP: www.nytimes.com adx_click.html?type="goto&page=www.nytimes.co<br" bin adx>m/printer-friendly&pos=Position1&camp=foxsearch2007-emailtools01d-nyt5-51127<BR>6&ad=animate2_namesake88x31.gif&goto=http://www.foxsearchlight.com/thenamesa<BR>ke/> <BR><BR><BR>________________________________<BR><BR>March 26, 2007<BR><BR>Aged, Frail and Denied Care by Their Insurers <BR><BR>By CHARLES DUHIGG<BR><HTTP: top charles_duhigg<br d people timestopics reference topics.nytimes.com>/index.html?inline=nyt-per> <BR><BR>CONRAD, Mont. — Mary Rose Derks
was a 65-year-old widow in 1990,<BR>when she began preparing for the day she could no longer care for herself.<BR>Every month, out of her grocery fund, she scrimped together about $100 for<BR>an insurance policy that promised to pay eventually for a room in an<BR>assisted living home. <BR><BR>On a May afternoon in 2002, after bouts of hypertension<BR><HTTP: news top topics.nytimes.com diseasesconditionsandhealthtopics<br health>/bloodpressure/index.html?inline=nyt-classifier> and diabetes<BR><HTTP: news top topics.nytimes.com diseasesconditionsandhealthtopics<br health>/diabetes/index.html?inline=nyt-classifier> had hospitalized her dozens of<BR>times, Mrs. Derks reluctantly agreed that it was time. She shed a few tears,<BR>watched her family pack her favorite blankets and rode to Beehive Homes,<BR>five blocks from her daughter’s farm equipment dealership.<BR><BR>At least, Mrs. Derks said at the time, she would not be a financial<BR>burden on her family.<BR><BR>But
when she filed a claim with her insurer, Conseco<BR><HTTP: www.nytimes.com MWredirect.html?MW="http://custom.marketwatch.com<br" mem>/custom/nyt-com/html-companyprofile.asp&symb=CNOPRB;CNOWS> , it said she had<BR>waited too long. Then it said Beehive Homes was not an approved facility,<BR>despite its state license. Eventually, Conseco argued that Mrs. Derks was<BR>not sufficiently infirm, despite her early-stage dementia and the 37 pills<BR>she takes each day. <BR><BR>After more than four years, Mrs. Derks, now 81, has yet to receive a<BR>penny from Conseco, while her family has paid about $70,000. Her daughter<BR>has sent Conseco dozens of bulky envelopes and spent hours on the phone.<BR>Each time the answer is the same: Denied.<BR><BR>Tens of thousands of elderly Americans have received life-prolonging<BR>care as a result of their long-term-care policies. With more than eight<BR>million customers, such insurance is one of the many products that companies<BR>are
pitching to older Americans reaching retirement.<BR><BR>Yet thousands of policyholders say they have received only excuses<BR>about why insurers will not pay. Interviews by The New York Times<BR><HTTP: www.nytimes.com MWredirect.html?MW="http://custom.marketwatch.com<br" mem>/custom/nyt-com/html-companyprofile.asp&symb=> and confidential depositions<BR>indicate that some long-term-care insurers have developed procedures that<BR>make it difficult — if not impossible — for policyholders to get paid. A<BR>review of more than 400 of the thousands of grievances and lawsuits filed in<BR>recent years shows elderly policyholders confronting unnecessary delays and<BR>overwhelming bureaucracies. In California alone, nearly one in every four<BR>long-term-care claims was denied in 2005, according to the state.<BR><BR>“The bottom line is that insurance companies make money when they<BR>don’t pay claims,” said Mary Beth Senkewicz, who resigned last year as a<BR>senior executive
at the National Association of Insurance Commissioners.<BR>“They’ll do anything to avoid paying, because if they wait long enough, they<BR>know the policyholders will die.” <BR><BR>In 2003, a subsidiary of Conseco, Bankers Life and Casualty, sent an<BR>85-year-old woman suffering from dementia the wrong form to fill out,<BR>according to a lawsuit, then denied her claim because of improper paperwork.<BR>Last year, according to another pending suit, the insurer Penn Treaty<BR>American<BR><HTTP: www.nytimes.com MWredirect.html?MW="http://custom.marketwatch.com<br" mem>/custom/nyt-com/html-companyprofile.asp&symb=PTA> decided that a<BR>92-year-old man had so improved that he should leave his nursing home<BR>despite his forgetfulness, anxiety and doctor’s orders to seek continued<BR>care. Another suit contended that a company owned by the John Hancock<BR>Insurance Company had tried to rescind the coverage of a 72-year-old man<BR>when he was diagnosed with
Alzheimer’s<BR><HTTP: news top topics.nytimes.com diseasesconditionsandhealthtopics<br health>/alzheimers/index.html?inline=nyt-classifier> disease four years after<BR>buying the policy.<BR><BR>In court filings, all three companies said the denials had been<BR>proper. They declined further comment on the cases, though Bankers Life and<BR>John Hancock eventually settled for unspecified amounts. <BR><BR>In general, insurers say criticisms of claims-handling are unfair<BR>because most policyholders are paid promptly and some denials are necessary<BR>to root out fraud. <BR><BR>In a statement, Conseco said the company “is committed to the<BR>highest standards for ethics, fairness and accountability, and strives to<BR>pay all claims in accordance with policy contracts.” Penn Treaty said in a<BR>statement, “We strive to treat all policyholders fairly, and to deliver the<BR>best, most efficient evaluation of their claim as possible.”<BR><BR>But policyholders have lodged
thousands of complaints against the<BR>major long-term-care insurers. A disproportionate number have focused on<BR>Conseco, its affiliate, Bankers Life, and Penn Treaty. In 2005, Conseco<BR>received more than one complaint regarding long-term-care insurance for<BR>every 383 such policyholders, according to data from the insurance<BR>commissioners’ association. Penn Treaty received one complaint for every<BR>1,207 long-term-care policyholders. (The complaints touch on a variety of<BR>topics, including claims handling, price increases and advertising methods.)<BR><BR>By comparison, Genworth Financial<BR><HTTP: www.nytimes.com MWredirect.html?MW="http://custom.marketwatch.com<br" mem>/custom/nyt-com/html-companyprofile.asp&symb=GNWPRE> , the largest<BR>long-term-care insurer, received only one complaint for every 12,434<BR>policies.<BR><BR>Conseco is among the nation’s largest insurers, collecting premiums<BR>worth more than $4.2 billion in 2006, of which
long-term-care policies<BR>contributed 21 percent. Penn Treaty focuses primarily on long-term-care<BR>products and collected premiums of about $320 million in 2004, the last year<BR>the company filed an audited annual report.<BR><BR>In depositions and interviews, current and former employees at<BR>Conseco, Bankers Life and Penn Treaty described business practices that<BR>denied or delayed policyholders’ claims for seemingly trivial reasons.<BR>Employees said they had been prohibited from making phone calls to<BR>policyholders and that claims had been abandoned without informing<BR>policyholders. Such tactics, advocates for the elderly say, are becoming<BR>common throughout the industry.<BR><BR>“These companies have essentially turned their bureaucracies into<BR>profit centers,” said Glenn R. Kantor, a California lawyer who has<BR>represented policyholders. <BR><BR>Yet these concerns have been ignored by state regulators, advocates<BR>say, and have gone unnoticed by federal
lawmakers who recently passed<BR>incentives intended to promote purchases of long-term-care policies, in the<BR>hopes of forestalling a Medicare funding crisis.<BR><BR>Conseco and Bankers Life “made it so hard to make a claim that<BR>people either died or gave up,” said Betty J. Hobel, a former Bankers Life<BR>agent in Cedar Rapids, Iowa. <BR><BR>“When someone is 70 or 80 years old,” she said, “how many times are<BR>they going to try before they just give up?”<BR><BR>A Race to Sell Policies<BR><BR>When Mrs. Derks bought her long-term-care policy from a door-to-door<BR>salesman in 1990, she was unaware that she represented the insurance<BR>industry’s newest gold mine.<BR><BR>Her husband had died eight years earlier of a stroke, leaving her to<BR>run a barley farm in northern Montana, where she lived with her three<BR>children and her aging mother. As she watched her own parent decline, Mrs.<BR>Derks became preoccupied with sparing her children the expense of her
final<BR>years.<BR><BR>“She was terrified that she would bankrupt us or get sent to a<BR>public nursing home,” said Ken E. Wheeler, her son-in-law. <BR><BR>At the time, long-term-care policies, which can cover the costs of<BR>assisted-living facilities, nursing homes and at-home care, were becoming<BR>one of the insurance industry’s fastest-growing products. Companies like<BR>Conseco, Bankers Life and Penn Treaty were aggressively signing up clients<BR>who were not in the best health at rates far below their competitors’ in<BR>order to win more business, former agents said. From 1991 to 1999,<BR>long-term-care sales helped drive total revenue gains of roughly 500 percent<BR>each at Penn Treaty and Conseco, including its affiliate Bankers Life. <BR><BR>Cracks in the business, however, soon started to appear. Insurance<BR>executives began warning they had underestimated how long policyholders<BR>would live after entering nursing homes. The costs of treating
Alzheimer’s,<BR>Parkinson’s<BR><HTTP: news top topics.nytimes.com diseasesconditionsandhealthtopics<br health>/parkinsonsdisease/index.html?inline=nyt-classifier> and diabetes<BR>ballooned. <BR><BR>As insurers began realizing their miscalculations, they persuaded<BR>insurance commissioners in California, Pennsylvania, Florida and other<BR>states to approve price increases of as much as 40 percent a year. <BR><BR>By 2002, Conseco’s long-term-care payouts exceeded revenue. Those<BR>and other disappointing results prompted the company to file for bankruptcy,<BR>from which it emerged 10 months later.<BR><BR>That same year, Mrs. Derks entered Beehive Homes, a cheery, 12-bed<BR>center one block from the Prairie View elementary school. In the previous<BR>four years, she had been hospitalized more than two dozen times. She had<BR>once lain unconscious in her living room for a day and a half. Her physician<BR>ordered her into an assisted-living center.<BR><BR>Initially, Conseco
told Mrs. Derks’s daughter, Jackie Wheeler, that<BR>her claim would go through smoothly, Mrs. Wheeler said. The family began<BR>paying Beehive Homes’s $1,900 monthly fee. <BR><BR>But three months after submitting her claim, Mrs. Derks received a<BR>letter from Conseco saying she had waited too long, and her earliest costs<BR>would not be reimbursed. Two months later, she received another letter<BR>denying her entire claim because she had not submitted proof of illness. <BR><BR>Yet a copy of Mrs. Derks’s policy, sent to the Wheelers by Conseco<BR>in 2004 and reviewed by The Times, mentions no requirement for proof of<BR>illness. The policy requires only that the confinement be ordered by a<BR>physician, and it allows for a notice of claim to be sent “as soon as<BR>reasonably possible.” <BR><BR>Mrs. Derks’s daughter called Conseco and explained that her mother<BR>could not recall the date or people’s names and had started multiple fires<BR>by forgetting to turn off the
stove. She sent letters stating that her<BR>mother needed assistance to dress, eat, go to the bathroom and inject<BR>insulin. <BR><BR>“This is medically necessary!!!” reads a form signed by Mrs. Derks’s<BR>physician in 2004. “This has been filled out three times! This person needs<BR>assistance!”<BR><BR>Seven months later, Conseco sent another letter, this time denying<BR>Mrs. Derks’s claim because her policy “requires a staffed registered nurse<BR>24 hours per day.” Her policy does not mention such a requirement. <BR><BR>Conseco also sent letters denying Mrs. Derks’s claim because her<BR>policy had an “assisted living facility rider,” and because Mrs. Derks “does<BR>not have an assisted living facility rider.” In all, the family received<BR>more than a dozen letters from the company. Many contradict one another, and<BR>frequently cite requirements that are nowhere mentioned in Mrs. Derks’s<BR>policy.<BR><BR>“There was always a new step in the runaround,” Mrs. Wheeler
said.<BR>“It felt like everything was designed to make me just go away.”<BR><BR>Over two years, Mrs. Wheeler estimated, she called the company about<BR>100 times. Twice a month, she sent envelopes stuffed with medical records.<BR>Some afternoons, she spent hours making calls. After one conversation, Mrs.<BR>Wheeler slammed down the phone and started to cry. Then she drove to Beehive<BR>Homes, where her mother was surrounded by faded photos of her childhood and<BR>boxes of adult diapers. <BR><BR>“I wouldn’t tell her about the problems we were having with Conseco,<BR>because I knew it would cause her so much worry,” Mrs. Wheeler said.<BR><BR>Eventually, the Wheelers sold part of their John Deere dealership to<BR>raise money to pay for her mother’s care. In October 2006, they sued.<BR><BR>Conseco, asked by a reporter about the company’s handling of the<BR>Derks claim, declined to answer, citing the pending litigation. In court<BR>documents, the company denied Mrs. Derks’s
allegations without specifying<BR>why her claim was denied. <BR><BR>“We did everything they asked,” Mrs. Wheeler said. “And this company<BR>just treats us like dirt.”<BR><BR>Tales of Bureaucracy<BR><BR>Inside the large Conseco headquarters in Carmel, Ind., scores of<BR>employees receive the flood of documents and calls that arrive each day. At<BR>times, according to depositions and interviews, that deluge became so<BR>overwhelming that documents were lost, calls went unreturned and mistakes<BR>occurred.<BR><BR>Some employees describe vast mailrooms where documents appear and<BR>disappear. One call-center representative said he was afforded an average of<BR>only four minutes to handle each policyholder’s call, no matter how<BR>complicated the questions. Employees said they were instructed not to say<BR>when the company was behind in processing paperwork, even when the backlog<BR>extended to 45 days. Workers were prohibited from contacting each other by<BR>phone, although
such calls might have quickly resolved obstacles, according<BR>to depositions.<BR><BR>Conseco, asked in detail about the company’s policies, declined to<BR>respond. <BR><BR>Bureaucratic obstacles were pervasive, according to interviews with<BR>10 former Conseco employees and depositions of more than a dozen others.<BR>Robert W. Ragle, a former Bankers Life branch manager, once contacted the<BR>claims department on behalf of a client, and “they just laughed us off the<BR>phone,” he said. “Their mentality is to keep every dollar they can.” Mr.<BR>Ragle was dismissed by Bankers Life in 2002. He sued for wrongful<BR>termination and settled out of court. <BR><BR>In lawsuits, complaints and interviews, policyholders contend that<BR>Conseco, Bankers Life or Penn Treaty denied claims because policyholders<BR>failed to submit unimportant paperwork; because daily nursing notes did not<BR>detail minute procedures; because policyholders filled out the wrong forms<BR>after receiving
them from the insurance companies; and because facilities<BR>were deemed inappropriate even though they were licensed by state<BR>regulators.<BR><BR>In depositions conducted on behalf of angry policyholders, Conseco<BR>employees described bureaucratic obstacles that prevented payment of claims.<BR>Those depositions were sealed in settlement agreements but were obtained by<BR>The Times.<BR><BR>In a 2006 deposition, a Bankers Life and Conseco claims adjuster,<BR>Teresa Carbonel, testified that she denied claims because of missing records<BR>but was prohibited from calling nursing homes or physicians to request the<BR>documents. She also testified that when a claim was denied, she was<BR>forbidden to phone a policyholder, but instead used a time-consuming mailing<BR>system.<BR><BR>Ms. Carbonel’s testimony, recorded during lawsuit on behalf of a<BR>94-year-old policyholder, Rhodes K. Scherer, also disclosed that if<BR>policyholders did not mail requested documents within 21
days, Conseco might<BR>abandon their claim, sometimes without informing them. <BR><BR>In the case of Mr. Scherer, who was institutionalized after a<BR>bathroom fall, it was difficult to obtain a response, Ms. Carbonel said,<BR>because the company’s requests were mailed to his home address, rather than<BR>the nursing center where the company had been notified that he had moved.<BR>Ms. Carbonel, who is no longer with the company, did not return calls.<BR>Conseco declined to comment on her testimony. <BR><BR>In another deposition, Conseco’s then-senior manager for long-term-<BR>care claims, Jose S. Torres, testified that Conseco would sometimes withhold<BR>payments until it received documents not required by customers’ policies. In<BR>Mr. Scherer’s case, Mr. Torres said, the company refused to pay his nursing<BR>home costs unless he sent copies of the home’s license, payment invoices and<BR>medical records, even though those documents had no bearing on approving his<BR>claim.
<BR><BR>Mr. Scherer’s claim “was handled not in the best way, but it was<BR>handled according to the processes and procedures placed at the time,” Mr.<BR>Torres testified. “Mistakes are going to be made, you know.”<BR><BR>Other executives testified that when Conseco appeared to have lost<BR>important documents in Mr. Scherer’s claim, no investigation was initiated.<BR>Shawn Michael Schechter, a Conseco claims supervisor who left the company in<BR>2005 on positive terms, according to the deposition, testified that the<BR>handling of Mr. Scherer’s claim violated the principle of good faith, which<BR>requires insurance companies to treat customers fairly.<BR><BR>“The claim adjuster could have made that very easy and not have put<BR>the burden back onto the policyholder,” he testified. <BR><BR>Mr. Torres did not return calls. Mr. Schechter declined to answer<BR>questions. <BR><BR>Mr. Scherer died in 2004 without receiving benefits from Conseco.<BR>His estate settled with the
company in February for an undisclosed amount,<BR>according to a lawyer representing the estate.<BR><BR>Conseco declined to discuss its complaint history or individual<BR>cases, citing confidentiality agreements. In its statement, the company said<BR>that in 2006, Conseco paid nearly $2.3 billion on 9.8 million claims in all<BR><BR>=== message truncated ===</BLOCKQUOTE><BR></mailto:vision2020@moscow.com></mailto:deco@moscow.com><p> 
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