My Mom does not have dementia or any checklist problems from their forms. What she has is limited vision at times, and she is unable to drive because of it. She needs home care to do basic things like take her to the grocery store and be her eyes to find items, help her read receipts, and clean house. Maybe also walk with her to make sure she does not fall on things she can't see.
The insurance company does not look at this as a reason for them to pay a claim or cover getting home care. Any suggestions?
Contact the licensing bureau of the (/her) insurance company and ask them to investigate.
Look at your (/her) contract.
Hire an attorney specializing in these areas.
Gena / Touch Matters
There are also some programs under Americore (if it still exists) which pairs volunteers with seniors in need.
And in regard to the LTC coverage, as many have said, it's all about the coding. Make sure you/ medical providers know the proper medical codes and buzz words that might qualify your mom for services. Don't assume doctors/nurses know this. They know medicine, but not necessarily how the elder care sytem operates.
Verify her LTD care policy with her agent since coded conditions for LTC must match the diagnostic codes to get benefits paid.
I would suggest investigating services for helping the visually impaired to obtain and use assistive equipment: voice aided computer for online shopping, white cane for walking, bump dots for household appliances, maybe an Echo Show for “what am I holding?”
My aunt worked with a very helpful group in Seattle.
I can’t see an insurance company paying out for failing vision alone.
Here is the language from one contract:
“Complex, Yet Stable Medical Condition means that twenty-four (24) hour a day nursing observation, or
professional nursing intervention more than once a day, in a setting other than the acute care unit of a hospital is
medically necessary, that is, the observation or intervention has been prescribed by a Physician and it is not
designed primarily for the convenience of You or Your family.”
But, since you are stuck with the insurance company, see if you can have a personal conversation with a client care rep and find out if there are any options for you. I have learned that they try to weasel out of paying any way they can. They delay processing, paying, and communicating. But you can try.