Caregiving Information and more!

 

 

Make sure you view the Medicare videos and learn about Medicare Part D!
Long-Term Care Insurance:
Read the Fine Print
December 2, 2008. By Gordon Gibb
newsletter-BCA-334565@lawyersandsettlements.com
Kansas City, MI: It is somewhat ironic that November was officially 'Long-Term Care Awareness Month' in the US, as observed by the American Association for Long Term Care Insurance. In fact, it should be noted that the US Congress passed a resolution just last year (H.R. 133, for sticklers of fact) in support of Long-Term Care Awareness Month, and it was reported that several Governors declared the same week in their respective jurisdictions.

However, perhaps Congress should put equal effort into addressing some of the long-term problems of long-term care insurance. As the baby boom ages, and more people are requiring long-term care, heartbreaking stories have been surfacing with regard to sudden, and unpredictable problems with collecting on long-term care polices.

Senior CoupleMany of those policies, held by extremely forward-thinking Americans, have been held for the long term. And now that the long term has evolved to the short term for them, surprises are in store.

It has been noted that the National Association of Insurance Commissioners (NAIC) conducted a survey of individual States to determine the extent of problems pertaining to denied claims. While there is some dispute reported with regard to the volume, and the actual number of denied claims between State regulators and the insurance industry, an individual claim denied often reveals an issue not addresses in State law, or the NAIC models which govern its supervision of the industry.

Assisted living, for example. While long-term care insurance is quite popular now and is being embraced as the baby boomers age, some policies have been around for decades and were adopted by a smaller number of forward-thinking policyholders decades ago. However, older policies may lack provisions for levels of care that are now beginning to emerge as commonplace. Such as assisted living, which has emerged as an alternative to nursing homes.

However few, if any long-term care policies included a benefit for assisted living prior to the mid 1990s. As well, the regulations for assisted living vary from State to State. Thus, even if a long-term care policy includes benefits for assisted living, insurance companies can, and have denied claims by challenging the status, the design, the staffing or services available.

If a long-term care policy was issued in one State, then used in another, such an attempt at transference could also be seen as a problem.

And there can be other bugaboos, too—such as home care. It has been found that many long-term care insurance companies define 'home' narrowly, and will often refuse to pay for benefits when care is given in any facility other than the individual's single-family residence.

The alternative is the allowance for care, so long as it is provided in another person's home (such as an adult child, or a good friend), or in some form of congregate living arrangement where around-the-clock care is clearly not provided.

Obviously, Mrs. "M" was looking long-term when she purchased long-term care insurance through Pioneer, which is now Conseco. She bought her policy in 1990, and also had the foresight to purchase an 8 percent compounded inflation protection benefit. However, she must have also been fully expecting to remain in her home, as the benefits offered by the policy were for home care only. No other benefits were included.

Now, Mrs. M is living in an assisted living facility licensed by the State of California. The home is also licensed to provide specialized services for dementia, which Mrs. M, at 84, clearly has.

The facility is an excellent choice for Mrs. M. It has round-the-clock supervision, together with specialized activities for dementia patients. Socialization with other patients experiencing similar emotional trauma is also important, and the facility also features this.

However, in spite of her prudent planning Mrs. M. has been denied benefits by her insurer, because even though the facility in which she currently resides is not licensed to provide skilled nursing care, and as such is not a skilled nursing facility, the insurer takes the view that it is. Thus her claim has been denied, she receives no benefits with zero return on her substantial, and hard-won investment. It has been reported that nowhere in Mrs. M's policy is a person's home defined, nor is there any kind of definition as to where policy benefits will be paid.

Conseco stood its ground. And an 84-year-old woman is out of luck.

Such is the murky world of long-term care insurance.

Hope everyone had a nice long-term care awareness month in November.

Long-Term Care Insurance Legal Help

If you have suffered losses in this case, please send your complaint to a lawyer who will review your possible [Long-Term Care Insurance Lawsuit] at no cost or obligation.

 

 

Welcome to Ohio's Best Rx

 

New! To apply on-line click here, or by telephone call 1-866-923-7879.

 

Ohio's "Best Rx" is a prescription drug discount card program designed to lower the cost of prescriptions for Ohio residents without prescription drug insurance coverage who are:

 

  • 60 years of age or over; OR
  • Under age 60 with annual family incomes of less than 300% of the Federal Poverty Level which is: $31,200 (single), $42,000 (family of two), $63,600 (family of four). Click here for income limits for larger families.

 

Please click one of the options to the left to learn more about Ohio's Best Rx.

OHIO'S BEST RX FACT SHEET:
OBRx Fact Sheet (40kb) PDF

 

OHIO’S BEST RX RENEWAL INFORMATION:

If your phone number or address has changed please contact Ohio's Best Rx at 1-866-923-7879 or via email to Ohio Best Rx.

 

 
Four Million Americans Find Help Through Partnership for Prescription Assistance. Read more.

Watch the "Help is Here Express" commercial, as seen on TV.

 
What is PPARx

The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

More about this program

Finding Programs

In order to find out what patient assistance programs you may qualify for, all you have to do is answer a few short eligibility questions. This site will help supply you with the information you need to get involved in a program and even allow you to download applications online. You can then follow the instructions on the application to apply.

 

 

 

CLL_Logo02.gif - 14512 Bytes

 

FREQUENTLY ASKED QUESTIONS:
MEDICARE AND MEDICAID

The Law Library Staff prepares "Frequently Asked Questions" for the convenience of our users to provide access to a variety of sources addressing particular points of law. These are general legal information sources, and are not to be construed as a substitute for personal legal advice from an attorney. Please seek legal counsel to help you determine the applicability of any of the information in these resources to your specific situation. The Cleveland Law Library makes no recommendation as to whether you should purchase any services offered by the websites contained in this FAQ.

 


 

 

 

 

MEDICARE

OHIO

 

FEDERAL

 

MEDICAID

OHIO

 

FEDERAL

 

 

 

 

List of Worst Nursing Homes Released

Posted: 2008-02-13 12:22:22
WASHINGTON (Feb. 6) - After initially resisting their disclosure, the Bush administration on Tuesday published the names of 131 nursing homes with poor inspection records and said some were already showing signs of improvement.
 
See the List: "Special Focus" Homes (PDF)
The list released by the Centers for Medicare and Medicaid Services represents troubled facilities cited as a "special focus facility," a designation used to identify those that merit more oversight. For these homes, states conduct inspections at six-month intervals rather than annually.

Last November, the government released a partial list of 54 nursing homes that ranked among the worst in their states, balking at releasing the full list of homes with the "special focus" designation. After a group of Democratic lawmakers began pushing for full disclosure, CMS said Tuesday it was publishing the names after cross-checking information to ensure the release of the most accurate data.

CMS will update its list of troubled nursing homes on a quarterly basis, with its next release scheduled for April.

"This is the latest in a series of steps we will be taking to improve quality and oversight in nursing homes," said Kerry Weems, CMS acting administrator. "We are issuing more information on special focus facilities to better equip beneficiaries, their families, and caregivers to make informed decisions and stimulate robust improvements in nursing homes having not improved their quality of care."

"This should just be one of the tools," Weems added. "There is no substitute for visiting the nursing home in person."

The list released Tuesday shows 52 nursing homes as not showing improvement after they were cited as a higher-risk nursing home, while another 52 did show some improvement. Twenty-seven nursing homes were added to the list in the last six months.

Out of the 54 nursing homes initially disclosed as poor performers last November, 21 have shown improvement, CMS said, adding that publicity about the problems might have played a factor.

There are about 16,400 nursing homes nationwide, and taxpayers spend about $72.5 billion annually to subsidize nursing home care.

While most nursing homes have some deficiencies, with the average being six to seven deficiencies per survey, the special focus facilities typically have about twice that number, and continue to have problems over a long period of time. However, the states determine which nursing homes should get the designation, and inspection standards vary among the states.

The offenses typically involve unnecessary use of medication for elderly residents, or inadequate safeguards to protect residents such as those with Alzheimer's from day-to-day hazards in the nursing home.

Sen. Herb Kohl, D-Wis., who chairs the Senate Special Committee on Aging, applauded CMS' move.

"We believe that Americans should have access to as much information about a nursing home as possible," he said. "We also agree that giving consumers more information about our nation's nursing homes is a good idea, but that doing so in a manner that causes a panic is not."

http://body.aol.com/news/health/article/_a/list-of-worst-nursing-homes-released/20080213102809990001