After a Kansas City, Mo., NBC affiliate highlighted the struggle of a patient’s family and regulators to battle for long-term care insurance coverage after buying a policy, the head of the health committee at the National Assocition of Insurance Commissioners has vowed stronger regulation for those LTC insurers that deny coverage even when it deemed valid.

The case involves a company issuing no benefit payments for over $165,000 in care for a Miriam Mills, a 93-year-old nursing home patient with memory lapses. Mills’ case was spotlighted by NBC Action News 41 in a story meant to expose the alleged problems with Bankers Life and Casualty Company, which serves seniors. 

Kansas Insurance Commissioner Sandy Praeger is quoted as saying the actions of the company are under review and could result in more regulatory action.

Kansas Insurance Commission records from 2010 show 24 complaints against Bankers Life, and the Bankers Life filings accounted for more than half of all long-term care complaints filed in Kansas, the news station reported.

“We are continuing to get complaints, so there may be additional fines going forward,” Praeger said to NBC 41.

Praeger, who will continue to chair the NAIC’s Health (B) and Managed Care Committee in 2012 and who was NAIC president during the AIG liquidity crisis, issued a statement to National Underwriter that puts long-term care insurance carriers on notice if they try to exploit elders.

“State insurance departments are very attuned to assisting older consumers and their families with long-term care issues,” Praeger said. “As witnessed in the past, we can band together to make sure that long-term care companies are fulfilling their contractual obligations to our consumers.” 

 

 

In this case, the patient’s son, Greg Mills, had created the website http://www.Bankers-Life.info to chronicle the battle, but it appears closed to the public at the time of this story’s publication and could not be accessed.

“The slick and smoothly scripted promises versus the harsh reality of doing business with Bankers Life and Casualty Long Term Health Care Insurance are two radically different things,” Mills’ site says in the lead sentence on Bankers-Life.info website, when it was up, according to NBC 41. “Despite numerous faxes, telephone calls, letters, a flood of paid nursing home statements, care plans forms and even a formal complaint filed with the Missouri Insurance Commissioner, no benefits have been paid,” Mills states on the web address he purchased, NMC reported.

When asked to comment, Bankers Life offered the same response that it offered NBC 41.

“We take all complaints seriously, and work with all parties, including the Department of Insurance, to resolve issues as soon as possible.  We fulfill our obligations to our policyholders based on specific policy language, state requirements and the claim information submitted as evidence of loss, such as plans of care and itemized bills,” Bankers Life said. “When incomplete evidence is submitted, we make every attempt to work with our policyholder and their family, and the provider to obtain the appropriate information to confirm what care is required and what services have been provided. In 2011, Bankers paid in excess of $400 million on long-term care claims and benefits to our more than 300,000 long-term care customers nationwide.”

According to the story, only when the media and Praeger got involved, via some fortuitous contacts, did Bankers Life contact Mills.

It seems Praeger’s own uncle had been undergoing a similar battle with the company, which is owned by Conseco, and it was Praeger herself who stepped in. She was quoted as saying that Bankers Life then began paying her uncle’s claim, but that the family is considering canceling the policy.