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Both of my parents have LTC policies which cover home health care for $245/ day. A company contacted them and said they could help them with their claim and help them qualify. The upfront fee would be $7,600. My parents have been very resistant to getting home care but now that they may be able to use this policy they are interested. I would be very relieved for them to get some help. My Dad recently had knee replacement surgery, has trouble with walking and is in a wheelchair part of the day, incontinence, recent falls and dizzyness, some dementia and doesn’t drive (my mom still does). Anyway here are my questions.



Has anyone used a service to help facilitate the claim with LTC in which the company charges a sizable upfront fee ($7,600).



Is it worth it? I have zero experience dealing with LTC insurance but I suspect they will not want to pay and I am wondering how difficult it will be to get Dad approved.



If we are able to get Dad approved will that likely continue long term? As he is 83 I don’t think he will improve a lot. Hopefully just maintain for awhile.



Thanks for any info.

I called the long term care policy company. They sent me the claim form. I filled the patient section and my doctor completed the medical part. My doctor gave me copies of the records they required. I photocopied the whole mess for my records and mailed the forms to the company. I mailed certified mail with return receipt requested. Postage cost was under $10.00. I got a phone call from the company to clarify a couple of things. Was approved within a few weeks and checks started coming to me the next month. The monthly amount is deposited directly into my checking account each month. I would not see the need for third party assistance. $7600.00 sounds like a lot of money to complete some forms. My husband bought our policies thru his retirement union and they told me if I had problems with the company to call them. My doctor did not charge me to fill out his part.
Helpful Answer (9)
Reply to Bridget66
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A fee to set up forms and “facilitate” Sounds like shipping and handling, where much of it is a scam
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Reply to Daughterof1930
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If they already have the policies, why do they need a middleman to help them qualify? A call (by you) to the LTC company that insures them would likely set things straight. You should never have to pay somebody else to "help" get something that's already yours! This reeks of a scam.
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Reply to Fawnby
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Sounds like a scam to me. If you have trouble, or don't want to do it yourself, get an elder law attorney to assist. Much less than $7,600!
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Reply to gladimhere
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Absolutely not. Call the insurance company directly to find out how to make a claim, what qualifies as a home care aide (they probably have to be licensed), etc.

There's no way they need a middle man to scam them out of $7k to do paperwork.
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Reply to MJ1929
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Absolutely DO NOT pay any company to "facilitate" any claim with an insurance company! I am a retired Certified Financial Planner Professional and have sold long-term care insurance in the past. Mom and Dad should first contact the insurance company (contact information should be found in the policy, which they should have in their records/file) and ask to talk to a representative who can inform them on how to file a claim. Also, if the insurance agent who sold them their policies is still available (this person's name should be found on the invoice billing the premium they receive from the insurance company), they should contact the agent and request help finding out what the requirements are for qualifying for benefits and how to submit claims. The company that has contacted them and wants to charge $7,600 should be reported to the state insurance department and the state attorney general!
Also, the policy should include information on the requirements for how to qualify for benefits. Generally, one must require assistance with 2 out of 6 activities of daily living - bathing, dressing, eating, transferring, toiletting, or assistance with incontinence. This will need to be verified by their doctor. The length of the waiting period (0, 30, 60, 90, 180 days or longer) during which Mom and Dad would pay for care will need to be met. Ask Mom and Dad to let you read the policy, and look at the benefits page - it will tell you the length of the time period (1, 2, 3, 4, 5, 6, 10, or longer) used to calculate the total lifetime benefit available. Example: $245/day for 3 years = $268,275 lifetime benefit. If they purchased inflation protection the initial daily benefit will have increased each year they have held the policy, so the lifetime benefit would also have increased. The insurance agent or the insurance company's representative can explain all of this to them, or to you (with Mom and Dad's permission).
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Reply to CareAdvocate
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I did the claim for my mother's LTC. Plenty of forms but pretty straightforward. It will take some time, but I found no evidence of the company trying to stonewall me. I agree with others - try it first before you spend that kind of $$.
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Reply to scrabblequeen
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These long term care companies are tough! My 94 year old dad had a stroke a few years ago. Had paid premiums for 20 years without one claim. He needed a little help which we arranged and they DENIED the claim! After about 4 phone calls going up the chain, pleading his case (he and mom live alone in own house 30 miles from me, their sole caretaker!), and hearing “ We are so sorry for you but we cannot approve this claim”, I thanked them tersely and said I’d be contacting the Boston Globe as I felt the readership should really understand what type of company they are running. Two days later I received a call from them. They had “reviewed” his case and agreed my dad WAS entitled to the help after all and approved the claim! The quote you got seems steep to me; I’d try this approach first!
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Reply to Martida
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In all honesty this seems like "a lot" to me. I might instead enlist the help of a license social worker in private practice or an elder law attorney. They will be cheaper by the hour I think.
I might also research any class action suits against this company or the filing of any complaints with the insurance commissioner in your area. This sounds not right to me.
I have seen some dreadful things with LTC. The worst was a policy that denied care compensation in facility unless there was 24/7 RN present; in all truth that just doesn't happen.
I sure do wish you luck.
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Reply to AlvaDeer
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Thanks all for your answers. I spoke to the rep from the company and it was more expensive than originally thought. 7600 for first year and 500 per month for every year after. I am working on setting up a meeting with an elder care attorney.

Unfortunately mother is again throwing up roadblocks about having anyone in her house. So I think we may be stuck again with disaster plan.
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Reply to Kmjfree
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