ONE WORD! This time, after submitting the request more than six times, the claim was accepted. I watched my brave, strong, caring husband lay his head in his arms on the kitchen table and cry from relief.This all started many years ago with my husband’s parents.
Suspecting they might need assistance as they aged, my mother and father-in-law considered several long-term care insurance plans. These policies are designed to protect one’s savings and investments from depletion and having to depend on Medicare or Medicaid for care. Depending on the policy, these insurance payments can also assist with the cost of hiring home health aides. Distributions from long-term care insurance are determined by the long-term care policy.
Conversely, those who have a maximum of $2000 in assets, depending on monthly income, may qualify for Medicaid. Unfortunately, using just Medicaid limits choice of care facilities. Nursing home care is expensive and can be upwards of $10,000 per month. Most long-term care policies have a specific value based upon the specific policy purchased by the insured. The distribution amount is determined by the insurance company, based upon the specific purchased policy at a per day rate, which dictates how many days of service they will fund.
After meeting with their investment advisor, my mother and father-in-law decided on a policy for each of them. My husband was relieved to know that they had sought out long-term care insurance. Faithfully paying the premiums for many years, they had a great deal of money invested. Sadly, my father-in-law started feeling ill in the fall of 2012. A diagnosis of leukemia came in December of that year, and due to an infection in his lungs, he died six weeks later. He never used a penny of his long-term care insurance. That is the conundrum with insurance. You hope you never need it, but glad you have it if you do. With long-term care insurance, you definitely hope you will be able to use it.
Five years later, my mother-in-law was not managing her money well. She would cash checks at the bank and then lose the money, so she would go to the bank again, cash another check and lose it as well. We saw that she was not making the best choices for her health. High blood pressure, diabetes, and failure to take her medications properly compounded her problems. She had several doctors and had perfected the art of playing them against each other to get the medications she wanted or thought she needed. We watched and tried to gently persuade her into making better decisions.
It all came to a head one day when she called my husband and said, “I need you!” She could not stand or get herself down the stairs. He took her to the emergency room and her blood sugar level was high and out of control. At that moment, our family physician became hers and we ended the services of her many other doctors.
My husband told her, “Mom, it’s time to start looking into long-term care facilities.” She was agreeable. What she did not know was that we had already researched the area assisted living facilities. There was only one facility that offered independent living alongside assisted and skilled care. We wanted her to live as independently as possible for as long as possible and we had her name on the list prior to this incident. The wait list was long, and it took nine months for an independent living apartment to become available.
So, in February of 2018, our family gradually moved her to the facility, and we began the process of selling her home of forty years. The constant demand to monitor her safety because of the stairs in her four-level home, the snow and ice to the mailbox, etc. would be finished. We felt relief.
However, looming in the background, her dementia was gaining ground. She had become a hermit after my father-in-law had passed away. We wanted mom to eat lunch and dinner at the dining hall in the hopes that she could engage with others and slow the failure of her mind. Six months had come and gone happily in her new home, but, after a minor fall, we saw a much steeper decline in her memory function. It was terrifying to find doses of meds in her pockets, on the floor and in drawers. With her dementia, there was a risk of overdosing or missing meds altogether. After a few months on the waiting list, and, against her will, she was moved to assisted living. Ironically, her humor would show itself, and a few weeks later, after her second move, she said how much she loved her new apartment and teased us that she had been trying to convince us to move there and wondered why we had kept her from it. Our family marveled at how her brain worked, and we were grateful that her wit would show up in conversation. Unfortunately, with the move to assisted living, Mom discovered that she could stay in her apartment for meals. She returned to self-isolation. She lived the last three years of her life in her own way, determining her own path, but safely under the care of wonderful medical and support staff.
Once she moved to assisted living, my husband began the process of putting in a claim to her long-term care insurance. She hadn’t qualified for the insurance while she was in independent living. Long-term care insurance is available only with assisted or full nursing care with a doctor’s recommendation. It cost Mom $3,400 per month for independent living. Assisted living was between $6,000 and $6,500. Since she had an income of $3,300 per month, her income alone wasn’t enough to pay for all the assisted living costs. The long-term care insurance would cover the difference. Without the insurance, it would have depleted her savings very quickly. My mother-in-law’s plan covered about $150 per day for nearly four years. After the four years, we would have had to pay for her care until her savings and investments were consumed.
Thus began the fight with her Long-Term Care Insurance Company. With the claim submitted, we had to get a letter from her doctor explaining why she needed assisted living. We then placed another claim. It was rejected with no reason given. My husband tried again. It was rejected. Another. Denied. We made phone calls to the insurance company. They said to change the wording on the claim and to resubmit, which we did. This was very general advice, with no specifics given. Again, it was rejected. We called the insurance company.
“Change the wording.” It was submitted with the changes. Rejected.
Regrettably, with each claim, the doctor had to rewrite his diagnosis. We felt terrible asking so much of him. Finally, my husband called and spoke with the most helpful man at the long-term care insurance company. He explained that there had to be one particular word on our claim and on the doctor’s letter. We called the doctor’s office and explained that that one word had to be used for the claim to go through. The doctor’s office staff passed on the message, and he graciously rewrote the letter using that one word. Rewriting the claim, using the required wording, we resubmitted our case to the long-term care insurance company. This time, after submitting the request more than six times and ultimately revisiting her power of attorney documents, the claim was accepted. I watched my brave, strong, caring husband lay his head in his arms on our kitchen table and cry from relief.
The long-term care insurance company did not need to make the process this difficult. We will be forever grateful for the one employee who knew our frustration and gave us the answer we had sought for months. The long-term care insurance company reimbursed us for the costs of the assisted living facility back to the date of the original claim, an enormous relief.
Patience is lost when it comes to dealing with insurance companies. They hold the policies, which customers have paid for, hostage in their tight fists so that they can keep the profits. There are policies available now which allow a surviving spouse to use any unused premiums of a deceased spouse. Those options were not available when my in-laws purchased their policies. When there is a fight for the insurance policy claim, elderly people are more likely to give up their right to the services for which they have paid. As their children and care providers, it is up to us to be their advocates, ensuring that they receive all the services they paid for, to enable them to live out their lives as safely, warmly and protected as possible. Advocacy is our gift to them. After all, they did this for us as children.
With about a year of the policy unused, my mother-in-law passed away. We are thankful that mom had the long-term care insurance. It allowed her to be served in an assisted living facility of her choice, providing more care than we would have been able to provide and gave us the freedom to enjoy her company without worrying about her finances.