Old long-term care insurance policy denies coverage: A warning to seniors and caregivers

HIGHLANDS RANCH, Colo. — A Greenwood Village man shared a warning with Steve On Your Side: if you have an older long-term care insurance policy sitting around, be sure to read the terms before you make another payment.

Mitch Gilbert has been caring for his 93-year-old father who has been in a memory care facility. When he took over his father’s finances, he found a Catastrophic Major Medical Care policy from United States Life.

The policy, which his father bought back in 2001, is meant to help cover the cost of convalescent care, which Gilbert assumed would help pay the bill for his father’s memory care bill.

“He can’t feed himself,” Gilbert said. “He can’t bathe himself, he can’t go to the bathroom. He can’t dress himself.”

“I’m in a catastrophe here with my dad,” he said. “So I thought we could file a claim and get what the benefits said.”

But Gilbert said his claim was denied. When he didn’t understand why, he said he figured the insurance company was playing hardball. So he decided to hire an attorney to help sort the situation out.

But the attorney got the denial too, but this time with an explanation. Gilbert’s father couldn’t claim the $300 a week for convalescent care because the policy required a nurse to be onsite 24 hours a day.

“Here they have a 24-hour nurse on staff, but it’s not in the house,” Gilbert said. “They have, like, six or seven houses, and she, you know, they go house to house, and so therefore they don’t qualify.”

Gilbert said he could move his father into a facility with a nurse on staff 24 hours a day, but it would cost an extra $6,000 a month, which wouldn’t make the extra $1,200 a week worth it.

Frustrated, Gilbert called 9NEWS Consumer Investigator Steve Staeger. But he wasn’t looking for help. He was looking to warn people.

“I called you because I feel like people need to look at their old policies,” Gilbert said. “This is a useless policy. He’s never going to be able to collect on it. He’s been paying. He’s paid, I’ve tracked since 2001, he’s paid well over $20,000 to $25,000 for this policy.”

Steve On Your Side contacted AMBA, which Gilbert said manages the policy. A spokesperson for the company said they could not comment on individuals, but provided a contact number for Gilbert to call. Gilbert told us he’s had productive conversations since then, but still isn’t optimistic he’ll ever see the money his father paid.

So Gilbert is cancelling the policy at the end of the year.

“I’m really hoping that someone sees this story and that they go look at their policy and they realize that their policy is useless, and 9NEWS saves them a ton of money,” he said. “That’s what I’m hoping for.”

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