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Do we contact the long term care insurance to see if they accept a facility or would the facility that we are thinking about do the submitting? Reason why I am asking this is because my brother is doing it himself. I would think that the facility would need to evaluate my mom first just to make sure that they would be able to take her. I trust him doing this but I would think the more information given to the insurance the better?

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Are you asking about how to submit an LTC claim?

Or are you asking about how to find out if a facility meets the criteria for using your mom's policy?

Or are you asking in what order should things be done?
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Judy79 Oct 2019
To submit a claim for the facility to be okay. Would it be the facility or is it okay for my brother to do it? Honestly, I don't know how it should be done. From what I was told, they need to assess her first then send something over to the ltc insurance? Because my brother doesn't know the medical part of it. And this time, the facility that we are looking at is licensed.
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Was it determined that the facility your mom is currently in does not meet the criteria for her policy?

If so, then CLEARLY the first step is getting a list of facilities that DO meet the criteria.

When my mom needed a NH, the discharge planners looked over mom's assets and together we determined that the first criteria needed to be "will keep patient once she goes on Medicaid after 2 years of private pay". This was step 1. Step 2 was finding a facility that met OUR criteria for cleanliness, staffing and cultural "good fit". Step 3 was having the fzcikty evaluate mom and decide if they could meet her needs.
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Judy79 Oct 2019
Yes to all of the above. My brother means well and he is doing the best that he can. I am going to the one facility on Saturday. I might end up taking my mom with me to visit but not sure. Don't think that they will have time to evaluate her then anyway. But I would think that they could go to where she is right now?
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Step one would be to find out if the LTCI will pay for a particular facility
Step two would be to visit that facility (and any others that the LTCI will pay for)
Step three would be to ask them to assess your mom and yes, they generally come to the patient.
I wouldn't take mom with dementia to see a facility until YOU guys had determined that it fit YOUR criteria.

Hope this helps; good luck!!!
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Judy79 Oct 2019
Thanks! I will mention it to them on Saturday about where she is. I will keep this in mind.
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