I would make a list of several questions for the insurance company. Ask all questions - including the one mentioned above - to get specific answers. It really depends on the insurance company and the specifics of the policy.
We have a LTC policy with a limit of $150/day. That's five hours @$30/hour I need to run for groceries, pharmacy, car maintenance, etc. Mom's neurologist has certified she cannot be left alone, but her ADLs are very good. LTC policies are written with ADLs as the primary focus but they should not be. Since the LTC policy will only pay if ADLs are impacted, I have an aide stand by to help her with dressing, bathing, and making breakfast/lunch. She won't need help most days, but she is always a fall risk due to her dementia.
TL:dr; insurance companies which require ADL impairment to receive benefits when dementia and fall risk are the issues that require assistance are just looking for reasons not to pay. Have your certifying neuro or GP put in at least three ADL stand by assists in case dementia/fall risk is not specified as qualifying for care. It's just more insurance company B.S.
I realize your situation may be different from ours. My point is, if that LTC policy is needed and does not take into account legit medical reasons other than ADLs, play it their way. Any decent neuro/GP who deals with LTC certifying will be happy to help you with this. Best of luck to you.
If your coverage is based on being unable to perform a certain number of ADLs and you can perform all of them you must notify the LTC provider. To do otherwise is fraud and could result in losing future benefits AND being required to repay some of those already given.
There is another side to the issue also: all LTC policies have dollar and/or time limits. What is your plan if you need LTC in the future and you have exhausted the limits of your policy by taking benefits when they are not needed?
We may be missing the point. The post may be from the policy holder and not the caregiver. If so, the post may be from an elder who is in an assisted living facility and wants to stay there but no longer needs the assistance. What would the correct answer be then?
Well, if the aide being paid is not suppose to do anything physical for him, doesn't matter he has improved. But surprised the LTC insurance is paying for an aide to to cleaning when there is another adult in the house who could possibly do it. Are you disabled in some way?
No, an aid comes to the house..mostly to do cleaning and dishes. I can't find anything in the forms that states if there is a change (for the better) in his health that the carrier should be notified
TL:dr; insurance companies which require ADL impairment to receive benefits when dementia and fall risk are the issues that require assistance are just looking for reasons not to pay. Have your certifying neuro or GP put in at least three ADL stand by assists in case dementia/fall risk is not specified as qualifying for care. It's just more insurance company B.S.
I realize your situation may be different from ours. My point is, if that LTC policy is needed and does not take into account legit medical reasons other than ADLs, play it their way. Any decent neuro/GP who deals with LTC certifying will be happy to help you with this. Best of luck to you.
There is another side to the issue also: all LTC policies have dollar and/or time limits. What is your plan if you need LTC in the future and you have exhausted the limits of your policy by taking benefits when they are not needed?
If so, when the facility submits an authorization and it's denied.