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Lawmakers Look Into LTC Allegations

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Leaders of the House Energy and Commerce Committee today asked two companies for documents relating to their handling of long term care insurance claims.

Rep. John Dingell, D-Mich., chairman of the committee, and Bart Stupak, D-Mich., chairman of the committee’s Oversight and Investigations Subcommittee, say they have concerns about accounts in a recent New York Times article of problems with the way the companies, Conseco Inc., Carmel, Ind., and Penn Treaty American Corp., Allentown, Pa., treat LTC insurance claims.

The accounts indicate that some LTC insurers “may have developed procedures that make it difficult–if not impossible–for policyholders to get paid,” Dingell and Stupak write in a letter to Conseco.

The Times article “described business practices that denied or delayed policyholders’ claims for seemingly trivial reasons,” Dingell and Stupak write in a second letter, to Penn Treaty.

“People who invest in long-term care policies and pay their premiums faithfully should be able to rely on those policies when the need arises,” Dingell says in a statement about the probe.

“As Congress considers ways to preserve the solvency of the Medicare Trust Fund and the long-term viability of the Medicaid program, we must ensure that people get what they pay for when they purchase long term care coverage and are not forced to use publicly financed programs,” Dingell says.

Stupak says the Energy and Commerce Committee investigation will focus on the practices and protocols that some of the larger long term care insurers use for handling claims and examine the effect of improper claims denials on the Medicaid and Medicare programs.

Dingell and Stupak are asking Conseco and Penn Treaty for information relating to all complaints, grievances, requests for reconsideration and appeals concerning the denial of claims from Sept. 10, 2003, to the present.

The lawmakers also have asked to see LTC insurance training manuals and claims processor job performance evaluation and bonus criteria.


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