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.
While my dad was in rehab from his stroke my mom and I talked about the kind of help dad needed, the kind of help she needed. My dad then transferred to a nursing care unit while we reconfigured the guest bathroom to accommodate a wheelchair (that's another story). I continued to work on my mom's attitude, what did she like about what I did for her. My mom was clear she could not help my dad (stroke, can't get up without help). He did all the cleaning - wouldn't it be nice to have someone clean the house. I cook when I am there. I live in Oregon, they are in Arizona and I am there 1-2 weeks out of every month since Nov 2021. Fortunately, my paying work is online and not full time and my employers are flexible.
We started with 24 hour care and backed off to 14 hours as my dad became able to move out of bed in an emergency (my definition). Our care group was recommended by our physical therapy team. My mother appreciated the change the physical therapy group has enabled in my dad and I verbally transferred that idea to the care group. My mother met the beginning caregivers (we have two that are solid and were there at the beginning. Six others did not work out for various reasons, but by that time my mom was sold...sort of.)
I was there when the caregivers were introduced and stayed a week with them to help the transition. Every time I am down to take care of financials etc, there is something else that needs my problem solving.
My parents have a 4 bedroom house - office, bedroom I stay in, caregiver "break" room with refrigerator, and primary bedroom. I feel VERY blessed they have LTC insurance (though painful to get info they will accept) and a house they can live in (stated goal to die at home) and caregivers they "adore". There are issues I hear about all the time, but it is much better than the nursing care facility my dad was in...and that is the threat -- if home, then caregivers, otherwise nursing care facility...which neither of them want. We are blessed, may others be blessed with perseverance too.
My uncle never got much use of his LTC insurance; he passed away after less of 6 months of starting to collect on this insurance.
My mom's LTC insurance requires that her caregiver comes from a licensed agency (ie, not private caregiver or relative) and there's other stipulations for continued reimbursement. Besides, they limit the total daily reimbursement. Her lifetime reimbursement is equal to the total amount she paid into the policy....she could have used this fund to invest in stocks/etc and got a higher return.
Document enter EVERY. SINGLE. COMMUNICATION with date. Whether it’s by phone, email, certified letter ( yes, I recommend doing this). Make copies of every single thing.
when you have to submit drs verification or anything MAKE COPIES.
It took me 5 months to get the initial payment. Now, every month I basically review every check. I make copies.
LTI will lose things constantly and in my cynicism, I think it’s on purpose.
it’s worth being a “dog with a stick”!!! Do not give up!!!
I hope your experience is better than mine. The policy is paying for my mom’s care ( mostly) and so I play the game.
Be nice to insurance company. It doesn’t do your claim any good to vent to them.
I wish you peace and luck… I know it’s hard, but you can do this!
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).
There was not any up front fee. If in time you need help you could hire a legitimate lawyer. Also be sure the facility is able to properly fill out forms to the LTC company so as to be reimbursed as we had to as we paid the facility directly monthly. Most AL and LTC facilities are well aware about doing this.
I certainly hope you avoid this person wanting this fee. It can be a bit tiresome at first starting the proces with a LTC company but it is manageable.
Bottom line: I would NOT do LTHC insurance again, nor can I recommend it.
Other helpful info: thoroughly read the policy as there may be some great features that they will not tell you such as:
3 week respite for the caregiver
11,000 in medical equipment. Mom got a leather lift chair that was $2500.00 which the policy paid. Medicare will only pay every 5 years for some things so when mom broke her walker her LTC paid to replace
If your parents start out with home care (minimum 4 hours a day) they are reimbursed and that counts towards the 50 day copay if they move to MC/ nursing home.
I personally will never have home health as we were stolen from multiple times and I was there sick (Lyme) when they came. Gutsy for sure and we used 3 different companies...wide spread issue. If you choose home care, definitely have multiple cameras and tell them you are recording to help with potential theft, treatment of your loved one and to know if there are actually working or playing on there phone/etc. Also, you pay for light housekeeping so take advantage of it. Mom asked a lady to wipe down the kitchen counter and she refused, mom fired her on the spot. You can't get much lighter than that.
If there is cognitive decline that helps also for qualifications.
These policies have been paid for years
My mother actually finally exhausted hers but it took a considerable amount of time and payments paid out.
I was required to have a CNA or a certified nursing assistant or they would not cover in home care. I live in a rural area so I struggled to find qualified caregivers.
When my husband eventually had to go into a nursing home the cost was over $6,000. a month but I could only collect $2,500 month from the LTC company. Secondly, there always seemed to be an issue when I submitted the invoice from the nursing home for reimbursement.
One time I was audited and had to print cancelled checks to prove that the check was actually cashed by the caregivers. I had to go back six months and produce the paperwork. I was so angry because I was exhausted from caring for my husband.
When my husband died there was a large amount of money unused because the LTC will only give you a defined amount of money each month. Leaving you to pay a huge sum out of pocket. Then they probably will not live long enough to use the amount of money they are entitled to.
I am 15 years younger than my husband, I will never purchase LTC insurance because I can't imagine my children keeping up with all the paper work for reimbursement. Much easier just to write checks from my account when the time comes.
Be very careful and understand what your benefits include.
I am 15 years younger than my husband a
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.
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 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.
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.