A man is warning others about hidden exclusions in long-term care insurance policies after his father's $25,000 policy was denied for memory care coverage.
HIGHLANDS RANCH, Colo. — Greenwood Village man shares warning with Steve on Your Side: If you have an old long-term care insurance policy, be sure to read the terms and conditions before paying again.
Mitch Gilbert continues to care for his 93-year-old father, who is in a memory care facility. When he took over his father's finances, he discovered catastrophic health insurance from United States Life.
The insurance, purchased by her father in 2001, was intended to cover the cost of convalescent care, and Gilbert thought it would help pay for her father's memory care.
“He can't feed himself,” Gilbert said. “He can't bathe himself, he can't go to the bathroom by himself. He can't dress himself.”
“I'm in a disaster here with my father,” he said. “So I thought I could file a claim and reap the benefits.”
But Mr Gilbert said his claims were denied. He said he didn't know why, but thought the insurance company was taking a hard line. So he decided to hire a lawyer to resolve the situation.
However, the lawyer also acknowledged the refusal, but this time an explanation was provided. Gilbert's father was unable to charge $300 a week for convalescent care because policy required a nurse to be present 24 hours a day.
“We have a nurse here 24 hours a day, but she's not at home,” Gilbert said. “They have six or seven homes and she goes door to door, so she doesn't qualify.”
Gilbert said her father could be moved to a facility with a 24-hour nurse, but it would cost an additional $6,000 a month and not worth the extra $1,200 a week.
Frustrated, Gilbert called 9NEWS consumer investigator Steve Stager. But he wasn't asking for help. He was trying to warn people.
“I called you because I felt people needed to look at old policies,” Gilbert said. “This is a wasteful policy. He'll never be able to collect it. He's paying money. I've been following him since 2001, and he's paid between $20,000 and $20,000 for this insurance. I was paying well over $5,000.”
steve on your side Gilbert said AMBA is administering the policy. A company spokeswoman said she could not comment on individuals but provided a contact number that Gilbert could call. Gilbert said they've had productive conversations since then, but she's still not optimistic she'll ever see the money her father paid.
So Gilbert decided to cancel his insurance at the end of the year.
“I really hope that someone sees this article, looks at their policies, realizes that their policies don't work, and saves a lot of money thanks to 9NEWS,” he said. “That's what I want.”
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