Does anyone have experience filing a long term care insurance claim?

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Dad with dementia has been placed into a memory care facility. He does not need help eating or bathing. He was living with mom but does not know who she is, wanted to kick her out of the house, then started wandering around the neighborhood. He is paranoid, delusional, can no longer be contained at home. Mom is burnt after 1-2 years of this and if it were to go on much longer she will be in poor health. They have a "Cadillac" LTC policy they've been paying on for almost 20 years. Hoping they won't get scr*w*d.

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If your dad has been referred for Hospice, take that up too! Mthr has been on hospice with her cancer as her primary dx, and dementia as her secondary. Hospice sends an aide to bathe, dress, and do her hair every morning during the week, and she has a nurse visit 2x month. She is still declining mentally, but she is happier with the additional care. When she's had a cold, they were able to give her a special inhaled medicine so she was not so scared - she'd forgotten how to blow her nose OR snort, so she was gasping for air. Hospice docs have lots of experience with medications for dementia, and completely changed what mthr was on for the better. They can treat the person at home or in a memory care unit.
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Oh yeah...I went through that.

My Dad could talk a good line,

I suggested to the person doing the evaluation...
take the recent electric bill and the check book. Ask my Dad to write a check to pay that bill.

Yeah, my Dad got really mad and yelling...trying to cover up his deficency.... he could not do it. And it really showed the insurance guy the real truth.
Talk is far too easy.
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Katiekate, thank you! Yes he can perform many small tasks associated with hygiene and eating but his cognitive ability has been bad for 2 years. The family doctor's notes from the past 2 years (every-three-month visits) all comment on Alzheimer's/Dementia and as of last fall they state "worsening symptoms", "elopement" and "referred to Hospice" for care. I'm hoping that's going to be solid evidence. The insurance company is sending an evaluator to see my dad tomorrow. Dad is an extremely intelligent man and can still carry on a seemingly normal conversation with a stranger.
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Oh yes, I had to file two such applications during this last year.

The insurance company will send you the applications. They should also have a help line for you to call with questions.

The biggest issue was that I needed to demonstrate that they could not perform 5 specific tasks..could walk alone, couldn't feed themselves, couldn't shower by themselves, couldn't dress themselves, couldn't toilet by them selves. I was in distress about that...because they were not totally bed ridden.

Then, the family lawyer told me that dementia trumps all that. Dementia is the sole diagnosis required to invoke the insurance!!

So...get that from the doctors.p to include in the application package.

Then...re-read everything in that policy. Every single detail is exactly what and how that policy will pay. Get to know it every well.

That elimination period is the actual days you self pay.   So..it doesn't start till he is in the AL.  And will exclude any days he is out "visiting" at home.
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Rainmom, thank you. Yes the specifications of your parents' policies sounds like the one my dad has. There is a 90 day elimination period before the insurance kicks in. I guess my concern is that my dad can do a lot of basic things for himself like personal hygiene and could come across as able to live independently, but his cognitive situation is such that keeping him home is no longer sustainable. My mother is so run down that if it goes on much longer, she will be facing major health concerns herself. I live nearby but am an only child, run a small business, and work 6 days a week. My parents situation is negatively affecting my business, income and marriage, and is beginning to affect my health. That about sums up our ability to take care of him if the insurance won't pay for him to stay in the ALF. I am hoping that the cognitive situation will over ride other issues for which he does not yet need help. Thanks to all for the responses!
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I think a lot depends on the policy itself- what it covers and how much it pays - there can be huge difference from company to company then policy to policy.

For instance - my parents made certain choices about their coverage that were designed to keep the premium reasonable.

First there was what I called "the deductible". It stated that my parents had to pay 24 weeks of care themselves before the policy would kick in. It was weird because what qualified was even just once a week and over an indefinite period of time. However - we started right away with conservative weeks and 3-5x a week but - this was in-home care at first, which had to be provided by a licensed agency.
Then the policy paid a daily amount but a different one for inHome care, AL and Nh. For us, as we graduated to a higher care the transition of payment went smooth enough. As to how we were paid - in my dads case we paid and they sent us a check - in my moms case they paid directly to the agency or facility. My parents had identical policies so I don't know why the difference.
Both parents had to met a criteria for the policy to start based on about seven different ADL's of which they had to not be able to met at least three. There was a cognitive criteria that if met, the other ADL criterias didn't matter.

As far as the company being easy to deal with - I really have no complaints although it did take around four months for them to activate my moms policy - but in the end it was worth it - they did a lot of research and actually went back and retro paid us for over a year. I had not asked for that so it was a pleasant surprise.

The last thing I can think of is that paying premiums stops when the policy activates.

That's it off the top of my head - let me know if you have specific questions.
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THANK YOU!
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Hi UpStream,

I'm sorry your family is going through this, but it sounds like memory care is the best option for both of your parents. We have an article on how to use a LTCI policy that I think could be of assistance:

Long-Term Care Insurance: How To Use a Policy and File a Claim
https://www.agingcare.com/articles/how-to-use-a-long-term-care-insurance-policy-198336.htm

Another point worth noting is that some service providers accept "assignment of benefits" aka direct payments from the insurance company (making things much easier on you and Mom). Providers that do not accept assignment require you to pay up front and then handle being reimbursed by the insurance company. Since your dad is already in the facility, this is definitely something to inquire about as you move forward in this process.

I'm sure other members will come along and share their personal experiences. Hang in there!

-AgingCareEditor
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I guess it depends on the terms of the policy. You would need to read it very carefully and see what they say in the small print (take your magnifying glass) My only first hand experience was with private disability insurance and that was a total night mare. They did everything they could not to pay. They delayed payment for a whole year by which time most people would have been so desperate they would have taken any job to put food on the table and that would have been the end of the benefit. Then they paid a lump sum for one year in the same year we started getting monthly payments and that had huge tax implications. As soon as hubby turned 62 the made him apply for SSDI and hired a lawyer to make this happen in record time. Then they deducted the amount of the SSDI from his monthly insurance payments.
Not trying to worry you but just telling you to be very very careful. You may need legal help to sort this.
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Well, nothing specific yet, we just started the process and my mom is the primary one dealing directly with the insurance company. She is nervous that they may want to deny the claim or make us bring him home and accept some type of home health care. I'm just looking for people's experiences, good and bad.
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