The State of Oregon has introduced new protections for consumers who buy long term care insurance coverage starting July 1, 2012.
According to a report from the American Association for Long-Term Care Insurance, an industry trade group, under the new law long-term care insurance policyholders must have claims paid promptly and have the right to appeal should the insurance company arrive at a decision to deny benefits. The new law also provides this protection to those with existing policies becoming effective when their policy renews.
Under the law long-term care insurance companies must pay claims that are submitted with all the required information within 30 days of receiving the claim. Should the insurer fail to pay on time, they must pay the claim plus interest.
In addition, policyholders may appeal an insurance company’s decision of ineligibility for benefits. Should the internal review by the company uphold the denial, the consumers may request an external review by an independent review organization. The insurance company pays for the cost for independent review.
“Consumers are entitled to have their claims paid promptly and to have the right to appeal,” states Jesse Slome, executive director of the Association, “and the long term care insurance industry pays out nearly $7 billion a year to over 200,000 claimants. When claims are denied it is generally because the person has not met the requirements of their policy.”
The Association points to a recently-conducted Department of Health and Human Services audit of insurers that noted that long term care insurance companies paid more claims than the auditors would have approved. “As more people own this protection, there are also fraudulent claims being filed,” Slome adds pointing to a recent report citing a single fraudulent claim amounting to nearly $600,000. “Insurers need protection as well,” he notes, “and mounting regulation is just one more reason long term care insurance companies decide to cease selling new policies and turn the bill for American’s long term care needs over to the State’s taxpayers.”
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