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Long term care insurance was created to provide care to those who need assistance on a long term basis. The concept itself is simple, but trying to get insurance companies to pay isn’t turning out be.

A group of long term care policyholders in the Midwest recently shared their stories of how they tried to get their insurance companies to honor the terms of their policies. Others reported that their premiums have nearly tripled in short periods of time. Here is what happened to them:

They believed what the door-to-door salesperson told them. An elderly couple purchased long term care insurance from a door to door salesman in 2001. Even though the wife had serious health issues and needed dialysis three times per week and nearly constant care from her husband, the salesman told them they would be covered if either one of them, for any reason, ever went into an assisted care facility.

Five years later, the husband became ill and couldn’t care for his wife. Both had to more into one of the facilities for which they bought coverage. However, the company never paid. They told the couple that because they could still feed themselves, dress themselves and go to the bathroom on their own, the company would not pay benefits. Eventually, after being threatened with a lawsuit, the insurance company returned the couple’s premiums and the agreement was voided.

Their benefits were suspended over a technicality. An elderly man was living in a nursing home where he had to be bathed, dressed, fed and taken to the bathroom every two hours. He had long term care insurance to pay for his expenses. One day, a nursing home employee wrote the word, ‘intermediate’ on his report for care by mistake. The insurance company, who said that benefits are not for those who only need ‘intermediate’ (less serious) care, stopped paying. Despite repeated attempts from family members and the nursing home that made the error, the insurance company simply didn’t respond and the patient had to be transferred to another facility.

Their monthly premiums continue to skyrocket. A couple in their 70’s purchased a long term care insurance policy in 2001 for $106 per month. Both are in good health and have never filed a claim. Despite this, their premiums nearly tripled in six years. Now, the couple is paying over $300 per month on a fixed income and is terribly afraid to cancel the policy because they fear that they won’t find coverage from another carrier at their age.

Their policy contained ambiguous terms. A couple purchased long term care insurance from a salesperson. The agreement stated that the company would pay for in-home health care for both the husband and wife. The husband then became ill and could not care for himself. His wife, feeling lucky to have purchased insurance, hired in-home health care for her husband and filed a claim. The company denied her claim saying that both she AND her husband must BOTH be unable to care for themselves before the company would pay benefits.

Don’t take NO for an answer

These policyholders’ experiences are similar to what’s happening around the country. Long term care insurers underestimated how much health care would rise and many of them, now regretting having sold these policies, are doing everything they can to avoid paying benefits. If you or a loved one has been denied valid long term care benefits, don’t take NO for an answer, contact an attorney who knows how insurance companies operate.