The costs of long-term and nursing home care are rising, study finds

May 07, 2013 (Press-News.org) The costs of long-term and nursing home care are rising, study finds

Article provided by Law Offices of Robert N. Grisham, II
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An annual study conducted by Genworth Financial, an insurance company that sells long-term care insurance, recently found that the national average for nursing home care has increased to $83,950 per year for a private room. That's a 24 percent increase since the first study was conducted 10 years ago, when the annual cost of nursing home care was $65,200.

The study estimated that insurance premiums, food, building maintenance and employee costs have all gone up in the last 10 years. Even shared rooms cost an average of $75,405 per year. Assisted living is relatively less expensive but provide fewer services and still cost $41,400 per year.

Paying for long-term care

Few people have the resources to cover the costs of needed long-term care out-of-pocket. For some, Medicaid may be an option, but Medicaid only covers low income and low asset people and it can be extraordinarily difficult for some people to become eligible, even if covering the cost of care at a nursing home is not at all possible. Many people, therefore, turn to long-term care insurance to cover these costs. Long-term care insurance is not covered under most employee-provided health insurance plans unless purchased separately.

This means dealing with insurance companies regarding their policies, exceptions and other minutiae prevalent in an insurance policy. For example, insurance companies have begun to eliminate policies that cover the lifetime costs of nursing home care. An insurance company with this product may offer lower premiums to policyholders with lifetime coverage, but in exchange the policy will limit the number of years the person is covered.

Denial of long-term care claims

Confusion regarding a long-term care policy by the policyholder can lead to an insurance company denying a completely legitimate claim. Common reasons for a denial or delay of a long-term care insurance claim include:
-The lack of a signature on some part of the claim form by the claimant or by a medical professional
-The insurance company claims the need for long-term care is overstated or the care is unneeded
-The insurance company's doctor, after a separate independent examination, claims there is no need for long-term care
-The insurance company claims it needs more documentation
-A dispute in the interpretation of language in the policy

Insurance companies have noted the high costs of long-term care. Several insurance providers have even eliminated this part of their business altogether. Because of its high costs, insurance companies take extra care to provide coverage only to people it deems need it. In addition, as in all industries, there are a few unethical individuals and companies who may deny a claim in bad faith or unreasonably delay providing coverage simply to avoid paying the high costs of care.

What to do if denied

Long-term care involves high stakes. If an elderly or disabled individual does not get the care he or she needs, dangers from malnutrition, dehydration, fractures from falls and other events can make an otherwise relatively functioning person rapidly become even more in need of care.

People who have been denied needed long-term care coverage should contact an experienced consumer law attorney familiar with litigating against insurance companies in a claim dispute to protect their rights.