Long-term care insurance. Any advice?

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.

You mean they will set them up with homecare? Will they monitor the situation. Meaning, if parents have problems with the agency they help them choose, will they step in and handle the problem? Find a new agency if fit not right.

Me, they must have a list of agencies that will accept the insurance. There is no qualifying as such. You call an agency and tell them what you need. Me, I think 7k is high for just setting them up.

The OP said this is to help get the claim approved - not set up care.

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.

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!

Momma has a Long Term Care Policy and I did not have to pay any additional money up front to get her qualified. Now it was a pain in the butt and alot of paperwork to get filled out but she qualified and they pay all of her assisted living fee every month. She has not met her Dailey limit of $271.00 a day.. Now she pays first out of pocket and then she gets reimbursed. Dad bought her this policy when she was 62. We did not have to pay the premiums anymore once she turned 85. Her policy at the beginning was over $500000.00. She still has over $330000.00 left . She is now 88. Now momma does have a trust and Nortwestern Mutual would not deposit into a trust so I had to open up her savings. They deposit directly into her savings and then I transfer into her checking.

A fee to set up forms and “facilitate” Sounds like shipping and handling, where much of it is a scam

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.

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.

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.

Don't spend money on a separate service! Contact the LTC insurance company directly, yourself. They will want you to jump through some hoops and provide lots of documentation, but they should be mostly oriented to helping you, if it's a major LTC insurance company. Make the calls, read the contracts, keep detailed notes. You can do this!

Here's another perspective. It's not really a scam, and it's much more than just completing a few forms to get LTC to pay up. I have a degree in insurance and know how the system works. The LTC insurance company will use every delay tactic and clause available to NOT pay your claim. I went through this with my mother's LTC insurance company last year. She's entitled to almost $7,300/month in benefits, and they didn't want to pay. I DID hire that company, and now they are reimbursing for her care. And it's completely hands-off for me. The company handles all of the contacts each month, and I no longer have to worry about it. Totally worth it.

My BFF did not have to pay a fee but it took several times of testing before she was approved.
Your loved one sounds like he needs to possibly be admitted to a memory care unit which will require testing to determine ability for independent living. I would contact the insurance commission to explain what the insurance company is demanding before approving the care your loved one has paid for already.

To trigger mom’s, I had to complete a one page form from her LTC insurance company, have each of her doctors complete a one page form, have her doctors send medical history and have the care provider company send their credentials. It didn’t cost a penny. The LTC company was great about reaching out to anyone they needed more info from. We changed caregiver companies a few times and each time those companies had to be qualified again, but now her bills are sent directly to LTC and she is reimbursed within 2 weeks after the end of the month. No need to have anyone do that for you. It’s very easy if you have a LTC company who helps with the process.

I would suggest you try it yourself before paying a service. I am sure LTC companies vary in how easy they are to work with and yours could be very easy.

I have an LTC policy but have no experience with claims yet, so these are just my thoughts if I were trying to obtain the benefits. I along with my family knows my history and have access to all the records so I would think a service may have to go through us anyway for some of the information. Our providers have been very willing to help us get benefits we are entitled because they know first hand our needs. My first impression is a company like this, if legitimate, can provide a very worthwhile service for clients where money is no problem or have no one available to advocate for them. Dealing with any insurance company takes time and a service can not guarantee they can do it any faster than we can do it ourselves. Most benefits date back to the day of application so I would try to hold off paying a service.

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 $$.

Hi I agree try yourself first. Most plans kick in after 60-90 days where a health care provider can attest that the person needs assistance with at least 2 out of 6 activities of daily living - cooking, bathing, dressing, toileting, eating, and transferring locations.

we had to have a family intervention to tell mom that dad could not take care of her without help anymore because he was injuring himself and his quality of life was affected. Difficult discussion but it worked. Good luck!

My parents had long term care insurance. You can purchase the insurance without an upfront fee. Getting the insurance to start paying is a whole other issue.

my parents were struggling, Mom could barely walk and Dad was in rehab. I had quite the job trying to get them to start paying out. I sent a video of my Mom trying to get up the three steps in front of their home and thet got the ball rolling. They sent a care scout out to do an evaluation, tons of paperwork had to be filled out along with paperwork done by the family physician.

after a 100 day stay in rehab for my Dad they finally started to pay out. I had my Moms started immediately. I moved them to assisted living near me and despite some bumps in the road they have payed out despite being behind a few times.

Dad died with $51,000 left on his policy and to bad for Mom, the greedy company kept it

I was sadly disappointed with my LTC insurer when I contacted them for help when I was 80 years old. I fought back, three years of calls and emails. I didn't have anyone to help me. I finally got approved but have not yet received reimbursement. What a disgrace to pretend LTC is there when you need them. Keep calling them, write to them. I wouldn't advise a company to do it for you in this world of scams against the elderly.

Have you had problems with a claim?
Has the LTC insurance denied any claim?
Have you contacted the LTC company to see what is required to enact the policy?
I would not pay to get a service you are already entitled to unless you have exhausted every route.

Would a lawyer specializing in collecting from insurance firms charge as much? I would be concerned about a company that "contacted" me unasked. Perhaps, I did not understand your question. We have had a relatively good experience with our particular company, after we finally read the agreement carefully (20 years after signing up). They have kept their word. I must confess we had a vague understanding of the agreement when we signed it. We are in AL; my impression is that most people have not had a very good experience with their insurance.

My mom does not have LTC insurance, but I know others who do. All policies are not the same so there is not an across the board answer. You will have to read the policy. Some have a limitation of time they cover, some have a limitation of money and some have limitations on both. I would read the policy, ask questions to the insurance company if you have them and attempt to use the policy on your own. If you run into problems, then it might make sense to pay a lawyer to navigate the plan. I personally wouldn't spend the money on a lawyer before trying it on my own.

I have a coworker who had LTC insurance on her husband. She kept him at home for as long as she could even though he was leaving the house and getting lost. It was very stressful. She said the policy had limitations and she was waiting until the last minute to place him and use the policy because she feared it would run out. The policy capped at $450,000. Seems like a lot right?.....The facility she placed him in was $12,000 per month. That means it would only cover roughly 3 yrs. Folks with dementia can live a long time. She ended up selling their home and he has since passed, but you can see where it can get tricky.

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!

In my opinion there is no reason for an upfront fee. I have used both my parents LTC policies for them and was never asked such a thing.

If your Dad is approved for LTC care, there will be a waiting period before benefits begin during which you will pay out of pocket for his care. When that time has passed, the LTC should begin paying toward his care and should continue paying until his policy cap is reached. The benefits LTC does pay may not be as much as you have to pay for care, but they may help. There will be obstacles to getting approved, but I would be VERY reluctant to pay anyone up front to help establish your claim. If not an outright scam, that sounds like taking advantage of a family's likely unfamiliarity with how LTC works.

If your medical group or hospital has a Social Services Dept, start there for help in how to work through LTC approval. Keep your $7600. You're going to need it.

i have a friend who is going thru this. her husband is 93 and she has to lay out the first approx. 10,000. she is dealing with a licensed insurance approved agency called visiting angels in the poconos pa. they assit her with questions,

It’s definitely a scam! When my mom needed care, I contacted the ho
e care agency and explained she had long term care insurance to help pay. I worked directly with them and the insurance company so that the insurance company paid the home health agency directly. There was no cost to do this. And as regard to of it is worth it…it was an old policy so didn’t have a very high pay per day rate, but once mom was in the nursing home it paid about 1/3 of the bill. When’s nursing home is $10,000 a month, that’s worth it.

Talk to your Elder Law Attorney or call for government protections: (copy and paste)
https://ncea.acl.gov/What-We-Do/Policy/Federal-Laws.aspx

This sounds like a scam. A company contacted them to say they could help. No no no. The whole reason they have a LTC policy is so when they need it they can use it. Contact the company that is holding the policy, not a separate company.

That’s crap! Call your parents’ LTC company and ask if it was they who called with this proposal. They will be able to tell you yes or no.