3.26.2007

denied

Here's a lovely picture from TGNOTFOTE.
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."

Profit, profit, profit before all. As long as someone's feeding from the trough, what do we care how many people suffer?

I recently wrote a story about the Americans with Disabilities Act, the landmark civil rights law for people with disabilities. In discussing where the disability rights movement is heading next, one of my interviews said, "Eventually people in the United States will realize that people have a right to health care. And the disability community will be in the forefront of that struggle."

The baby boomers, too, will play a part. Living longer, accustomed to comfort, and possibly a lot less well off than they intended to be, they will swell the ranks of Americans needing long-term care.

Will they fight for it - now, while they can? Will they even recognize this fight - against for-profit health care, for universal insurance - as their own?

New York Times story here.

9 comments:

M. Yass said...

It's not just LTC insurance.

For those of you just tuning in, my first paralegal job was working for an attorney who defended Allstate car wreck cases. We would routinely deny liability on rear-end collisions.

In one case, both parties to the accident had Allstate. The claimant's back surgery was covered by Allstate PIP, yet Allstate third party denied liability (I was working for an attorney who represented the plaintiff at this point.) We just sent the defendant a set of Requests for Admission regarding the reasonableness and necessity of the back surgery that Allstate paid for. Allstate came out with their hands up at this point.

Other common tactics included use of private investigators to spy on claimants and "independent" record reviews and medical examinations. Needless to say, the doctors who conducted these "independent" examinations were in fact little better than whores. They diagnosed what they were told to diagnose. One doctor had the following line in every single one of his reports: "This patient will continue to report pain symptoms for as long as it suits her to do so."

A smart attorney can use these tactics against them. It's very simple - you allow your client to submit to the exam. When the predictable bad report comes back, you depose the doctor. At that point, he has to admit that 100% of his practice consists of "independent" medical examinations for insurance companies. Sadly, many PI firms are little more than demand mills who screw their clients by persuading them to accept Allsnake's piddly offer. It is against these shysters that Allstate's tactics work.

That's Allstate's stand. And no, you are not in Good Hands if you come up against them.

loneprimate said...

It really is disgusting. I spent some time over the past couple of weeks visiting, reading, and commenting on a conservative's blog; a rather vicious "Christian" who holds that the government can't do anything right (of course, he holds that the reason the military works so well is the government lets it run itself...), that welfare is theft, and that government run health insurance is little more than another word for murder. Eventually I was tossed off the blog for (respectfully) arguing counter to their points. But this is the what people are up against, not just there but here as well. Private insurance is a mug's game. A private insurance company ruined my aunt and uncle just when they needed them most. Never mind the lawyers; first thing we do, let's kill all the insurance executives.

L-girl said...

Thanks for the inside perspective, M. Yass. It's definitely not just long-term care. But these kinds of examples illustrate the issues with leaving health care in the hands of people motivated solely by profit.

L/P, sounds like quite the "Christians" you ran into. I always wonder what happens to people like that if they ever need help. If they worked for Enron, let's say, and lost not only their job and their health insurance but their entire life savings, too. Do they blame themselves? Do they think it's part of a divine plan? Or do they suddenly thing maybe public assistance isn't such a bad idea after all...?

Whenever anyone claims that Hillary Clinton tried to get universal health coverage off the ground, remember that the private insurance companies loved her plan. They were drooling over it, because they stood to profit hugely. That tells me most of what I need to know about that plan.

M@ said...

Insurance is highway robbery, plain and simple. We are required to buy insurance to drive, something that we are otherwise completely qualified to do; however, insurance companies are not actually required to insure us. They have absolutely no responsibilities to the people who pay them. And yet if I drive without coverage, I get a ticket.

I don't know if Canadian insurance companies are as bad as American ones. But it's so much more chilling when health insurance is involved. The worst that can happen to me is that I pay for my own glasses or something (oh, and eye checkups -- thanks, Dalton). In the US, it's life and death. Sickening.

My wife's grandfather was once informed -- by a form letter -- that his business would no longer be insured by the insurer he had paid in full for 23 years. Evander at least made it into a good story, how he salvaged a little pride from the situation, but it remains a common event to be screwed by an insurance company. And what recourse does a 78-year-old, nearly-deaf engineer have? Well, unfortunately, not much. I can just imagine if it was his life on the line. Evander was lucky enough to have a system and a family that helped him to the bitter end.

And there I go on another of my rambling semi-non-sequiturs. You know, I actually have a couple of blogs of my own somewhere...

L-girl said...

We are required to buy insurance to drive, something that we are otherwise completely qualified to do; however, insurance companies are not actually required to insure us. They have absolutely no responsibilities to the people who pay them. And yet if I drive without coverage, I get a ticket.

And if you ever need to use your insurance - if you ever put in a claim - your rates go up! It's insane. It's a pure scam.

But it's so much more chilling when health insurance is involved. The worst that can happen to me is that I pay for my own glasses or something (oh, and eye checkups -- thanks, Dalton). In the US, it's life and death. Sickening.

Yes, that's the difference. And it's a huge one.

By the way, your "rambling semi-non-sequiturs" never seem as rambling or as non-sequitur-ish as you think. Worry not.

L-girl said...

The worst that can happen to me is that I pay for my own glasses or something

This is something I've been meaning to blog about for a long time.

Not M@ paying for his own glasses. :) More soon, maybe tomorrow.

M@ said...

This is something I've been meaning to blog about for a long time.

Not M@ paying for his own glasses. :)


Though that is a valid topic -- I think at least a portion of your readership will find the subject fascinating.

L-girl said...

I think at least a portion of your readership will find the subject fascinating.

..."portion" being a very imprecise term. :)

James said...

One of the fundamental problems with "let the market solve the problem" is that it's just not profitable to provide goods and services to people who can't afford them, but there are goods and services without which people will die.

I often find it hard to comprehend why some market-solves-everything people don't seem to realize this... Then I remember people like my uncle, who thought school teachers make six-digit salaries, or that Republican congressman who thought $200,000 US was "middle class", and that nobody made as little as $30,000.