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Who's afraid of long-term care? Californians

April 21, 2010 |  9:41 am

Cane Two-thirds of registered voters in California, those 40 and older anyway, say they worry about whether or not they could afford long-term care for themselves or a family member, finds a new poll from the SCAN Foundation and the UCLA Center for Health Policy Research.

Here are the poll results and the news release.

They're right to worry.

As the L.A. Times' Michael Hiltzik noted in his recent column, Long-term-care policies: Pouring money down a hole?:

"Here's a lesson baby boomers are just beginning to learn: You pay for long-term-care insurance for years, even decades, and then your insurance company changes the rules."

But Bruce Chernof, president and chief executive of the SCAN Foundation, seems cautiously optimistic in the wake of the recent healthcare overhaul. As he noted in his recent opinion article, Healthcare reform: What's in it for our seniors?:

"Lost in the maelstrom of misinformation, however, is the reality that the newly passed legislation lays the groundwork for greatly improving the full continuum of healthcare services for seniors, which includes renovating our nation's nonexistent long-term care system."

Here's more on how the healthcare overhaul would affect long-term care, courtesy Kaiser Health News.

-- Tami Dennis

Photo credit: Justin Sullivan / Getty Images



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Comments (2)

Actually, you are incorrect. Insurers can not change the rules because they have established a contractual agreement between the policyholder and the company. These are regulated by the State(s). Rates can change.

The new government plan that SCAN and others advocated for are not regulated. They are neither bound by a contract. The government department (Health and Human Services) will establish the rules and can change them at any time.

That's the truth.
Jesse Slome
Executive Director
American Association for Long-Term Care Insurance
Los Angeles, CA

According to the March, 2007, NY Times article, the leading long term care insurers average one complaint for every 10,000 policyholders. According to that same article, the largest long term care insurer averages only one complaint for every 12,434 policyholders.

According to the Des Moines Register, only 18% of long term care insurance complaints are “claims-related”. That means the leading long term care insurers receive one “claims-related complaint” for every 55,550 policyholders.

Long term care insurance is regulated on both the state and federal level. Every long term care insurance policy has a specific “claims process” that must meet state and federal guidelines.

Each policy also has a simple, step-by-step “appeals process” if the claim is initially declined. If a claim is declined the insurer is required to delineate the reasons for denial. Appealing a denied claim rarely requires an attorney. In most cases, it simply requires a clarification of information provided by your doctor or care provider.

According to Sen. Grassley, 70% of LTCi claims that are initially declined are approved after the “appeals process”. This indicates that there is a lack of understanding in the healthcare industry of what is needed to process a claim for long term care. Most healthcare professionals are accustomed to processing medical insurance claims, not long term care claims. Fortunately, the appeals process works.

About 20% of the people who need long-term care end up needing care for 5 years or more. The risk of needing 5 years or more of long term care is significantly higher than the risk of having a long term care insurance claim denied.

Scott A. Olson


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