I paid the first months rent and am getting ready to move my parents in. I have been told that I have to pay the first 90 days before the insurance will pay. What if they get denied? Is it possible?
Most LTC policies have a 90 "elimination period". Those first 3 months of rent should come out of your parents' assets.
In order to find out if the facility will be covered by the LTC policy you need to make sure that your parents qualify for coverage based on a professional assessment t of their ability to care for themselves, AND that the facility meets the requirements of the policy.
Some LTC policies will ONLY pay for nursing home care, while others will also pay for Assisted Living if the client meets certain criteria. Some policies will only pay for a facility that has an RN on staff 24/7.
Really, you need to talk with the insurance company AND the facility to make sure they are covered before your parents take up residence.
I agree: you need to confirm that the insurance will cover care in the place you are moving them to. Is this an assisted living place that has other residents who are "on claim" for LTC benefits?
If you can find the policy evidence of coverage, it should tell you how they qualify. If they have a web site, you may be able to set up an account and download a copy.
It might look like: "Nursing Home Benefit We will pay the Nursing Home Benefit when We determine that You have: a Deficiency in three (3) or more Activities of Daily Living; or a Cognitive Impairment; or a Complex, Yet Stable Medical Condition; and You incur covered expenses. All Other Benefits We will pay all other benefits when We determine that You have: • a Deficiency in two (2) or more Activities of Daily Living; or • a Cognitive Impairment; or • a Complex, Yet Stable Medical Condition; and You incur covered expenses."
Check your policy. With my mom, the dementia diagnosis was enough so didnt have to need as much help with ADL. My mom needed at that time more help with IDL, like medication management, reminders to eat, more help completing tasks,etc. We started the process of getting approved when she put the deposit down which was about 30 days before she moved in. There was a lot of paperwork involved, but my mom has a great policy through Genworth. They also wanted copies of my POA so I could do paperwork. And once they start paying benefits, she didnt have to pay monthly policy payments anymore
The business person at the facility can look at your policy and see if they qualify. When you file claim, they will send someone to the facility to evaluate it and her care plan. If your policy requires a certain number of ADL assistance, make sure that is documented in her care plan. also they did a cognitive evaluation for themselves, did not use her doctors or facility one. It really annoyed my mom, that lady was there talking to her for a couple hours.
The way my mom's facility and her LTC works is that they auto debit her fees from her bank account, and they send an itemized bill to the LTC insurance, the LTC insurance then pays the claim by auto depositing money in my moms account. My mom's policy had a 90 day period that she paid all of it on her own.
Ssomething to consider with Covid. If you take her out for either hospitalized or just to your house, even if you still pay rent, check her policy, because you could restart another 90 day exclusion period if she stays gone too long, depends on policy,
Speak with the insurance company to understand how it works to avoid any surprises.
In order to find out if the facility will be covered by the LTC policy you need to make sure that your parents qualify for coverage based on a professional assessment t of their ability to care for themselves, AND that the facility meets the requirements of the policy.
Some LTC policies will ONLY pay for nursing home care, while others will also pay for Assisted Living if the client meets certain criteria. Some policies will only pay for a facility that has an RN on staff 24/7.
Really, you need to talk with the insurance company AND the facility to make sure they are covered before your parents take up residence.
If you can find the policy evidence of coverage, it should tell you how they qualify. If they have a web site, you may be able to set up an account and download a copy.
It might look like:
"Nursing Home Benefit
We will pay the Nursing Home Benefit when We determine that You have:
a Deficiency in three (3) or more Activities of Daily Living; or
a Cognitive Impairment; or
a Complex, Yet Stable Medical Condition; and You incur covered expenses.
All Other Benefits
We will pay all other benefits when We determine that You have:
• a Deficiency in two (2) or more Activities of Daily Living; or
• a Cognitive Impairment; or
• a Complex, Yet Stable Medical Condition; and You incur covered expenses."
The business person at the facility can look at your policy and see if they qualify. When you file claim, they will send someone to the facility to evaluate it and her care plan. If your policy requires a certain number of ADL assistance, make sure that is documented in her care plan. also they did a cognitive evaluation for themselves, did not use her doctors or facility one. It really annoyed my mom, that lady was there talking to her for a couple hours.
The way my mom's facility and her LTC works is that they auto debit her fees from her bank account, and they send an itemized bill to the LTC insurance, the LTC insurance then pays the claim by auto depositing money in my moms account. My mom's policy had a 90 day period that she paid all of it on her own.
Ssomething to consider with Covid. If you take her out for either hospitalized or just to your house, even if you still pay rent, check her policy, because you could restart another 90 day exclusion period if she stays gone too long, depends on policy,