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My mom has pulminary fibrosis, demonstrates some memory issues, is on oxygen 24/7. She has mobility issues, needs help bathing and dealing with her oxygen machines. Her Long-term insurance stated that she needed to be living in assisted living before they could assess her abilities to qualify. Now that she has given up her daily routine and moved into a lovely assisted living program that she can not afford without her long term insurance... what in the world am I supposed to do. I think this system is cruel and heartless and I am stunned that they will not provide financial assistance especially after my mom has paid for years. Has anyone else experienced this?

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Did they give you specific reasons as to why the claim was denied?
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I went through the LTC insurance thing with both my parents. For the most part I didn't have too many issues beyond the actual pay out structure which was something my parents had worked on years and years ago with the agent who sold them the policy. But as far as my parents being assessed and approved- it actually went pretty smoothly. In my moms case it did take close to three months for them to approve her as they really poured over her medical records and records kept by the private caregiver agency we had been using - but in the end they retro'd back a full year before I actually had applied for the benefits to be activated so it was worth it. My parents were assessed strictly on a number of ADLs and then cognitive impairment- which was a more grey area that the ADLs. The requirement that your mom already be living in AL seems odd but really doesn't surprise me too much. After reading the details of my parents policies nothing would surprise me. I'm not convinced LTC insurance is as fabulous as it's made out to be as I know that neither of my parents got back what they paid in and I wonder if all that premium money couldn't have be better used in a good investment. But the devil was in the details and my parents policies had some oddities to them - that's for sure.
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Since she is living in assisted living - are they refusing to assess her ?

I went through this process at the beginning of the year - it is time consuming and you have to be diligent in following up with all parties - the insurance dept - the facility and mom's Doctor which must fill out paperwork too

Surprisingly mom's facility required the most follow up to get its paperwork done

Surprise to me was that mom's policy which she has had since the early 90s was frozen when she turned 85 - 8 years ago - and she only receives 60% of her benefit amount as memory care is not the same as a nursing home

If you believe mom's policy is denying her benefits then you should contact your state insurance commissioner - but I suspect it is more a matter of coordinating all their paperwork first rather than an appeal of their denial of her claim
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