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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.

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Prayer, persistence and perseverance got me to an equilibrium with my parents and caregiving. My mom vehemently resisted having someone in the house.
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.
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an agency like visiting angels in pa will handle the policy for you but generally you have to lay out money first,
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Hello, my mother has an LTC policy with StateFarm. We needed to submit a claim after her stroke. I called them directly and they sent all the paperwork to get the claim rolling. They worked directly with us if we had questions or did not understand the paperwork. You will need to obtain your parents LTC policy so you can determine if your parents qualify for activating a claim, or call the LTC Insurance company directly that wrote the policy.
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My mother and uncle both had paid into the same LTC insurance policies. After seeing what they have/are going through with LTC reimbursement, I don't think it's worth it. We and my sibs have determined that instead of paying for LTC, it's better to just put the monies aside (even invest this) and one would have more flexibility in one's own LTC in the future as needed.
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.
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The insurance company who sold the policy should be able to provide some assistance. It doesn't sound like qualification should be an issue. Never knew there were companies that did that. The insurance company case manager just reviewed the required documents to file a claim. If through an agency, the nursing or therapy staff may do a separate assessment. I would contact the insurance company directly.
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Also keep in mind most states have a division w/in the state insurance department or commissioner that may be able to answer questions or direct one for guidance.
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Sounds like a scam to me. The agency providing health care for my wife assisted me with this...not some private company trolling for business.
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Yikes! To your original question ~ nope, do not pay anyone! You can do this with persistence!!🤗
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Omg…. Ok. Buckle up! My mom bought long term care from a very well known insurance company. When it was time to access the benefits it was a nightmare. I’m not saying this will happen to you, but here’s my advise… buy a binder and hole puncher.
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!
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Kmjfree: Imho, $7,600 appears to be a extraordinarily large "upfront fee." I would be wary of that from the get go.
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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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When my mother first entered AL a representative from the facility I desired came to the rehab facility she was at and evaluated her there. I contacted the company that had her LTC policy to start the process.

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.
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I've had a LTC policy for my husband & I since I was in my late 40's, and now am in my early 70's. Supposedly they were not suppose to increase the premium, but they did for the two of us is about $6500.00. No one should be charging you an outrageous upfront fee to help you apply for the insurance. We used the policy when my husband was nearly dead w/ infection and during his recovery. The insurance company was miserable to work with, but once the claim got established, it paid until the care service wasn't needed. I found, when I was the most stressed is when the insurance company became most difficult and tedious to work with, but I dug in until I got approved for care coverage. With LTC - there are usually qualifiers, such as the patient cannot perform 3 of 5 basic living things, like getting to the bathroom, bathing & walking... for example. Do review your parents policy. Do not use the service wanting to exploit your finances to process the policy. Good luck, stay protected.
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Ugh. All I can say is that 25 years ago, through my employer, I was able to 'take advantage' of a group (my employer) LTHC plan. Sounded good to me! I was also able to enroll my mom (widowed and 65 at the time), and she was also enthusiastic. I knew it sounded complicated in terms of payout, but figured I'd deal with it 'then'. Five years ago, my mom needed it, for real. What a nightmare. Since my older sister lived 300 miles away and I was the boots-on-the-ground, live-in caretaker, older sister dealt with it (phew!). I realized then that when I needed it, I'd have to hire an eldercare attorney to do what my older sister did for my mom. Well, I don't need it (quite yet); but last month I received a notice that my monthly premiums (which I could handle when I was working full time, and I'm not now, I'm on Medicare) would be increasing about 65% (which would put me in the poorhouse). Or, I could cash out at $60K; an easy decision: I will put that 60K in a money market account and deposit the same amount I've been paying for premiums into that account.

Bottom line: I would NOT do LTHC insurance again, nor can I recommend it.
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Sounds like a big time scam. Each LTC benefit is governed by the policy that was generated at time of purchase. Locate the policy and read it carefully. Your parents paid many premiums to obtain a benefit - there should be no need for up-front money. Ask the scammer company to tell you what provision in the LTC policy calls for an upfront payment and then tell them that once they identify that provision, you will have your attorney review it. There are many elder care laws that protect the elderly from scams. Each state has a regulatory commission or agency on insurance that can advise you on this issue. Good luck and God bless.
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It sounds like a scam. You can clearly get qualified without it. Both my parents have/had Genworth. They send a local company to assess them. My parents policy is a lifetime policy but some are only 5 years. They do not even write policies like that now as they were losing money. They base approval based on how many tasks they need assistance with: showering, toileting, eating, etc. You have to have 3 of the 5 to qualify. They will drag it out but just call the insurance commissioner and magically they are approved.

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.
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Sounds like a scam.
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A LTC rep. recently told me that their insurer has to satisfy two out of six categories for home-care needs and must be assessed by his primary doctor in order to get approval of using their LTC policy. So I'm not sure if this "upfront fee" is for this kind of arrangement? Talking to the LTC insurance company directly could help find out the answer for the purpose of this fee.
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R
Riverdale Nov 2022
If you are speaking of ADL's they actually vary by state but I don't think 6 is required for AL. It is fairly easy for them to include med management which is already a requirement in most facilities,help with bathing and dressing
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.
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my husband had LTC for years, he recently died of Covid and late stage Parkinson Disease. I never heard of someone charging an upfront fee to process a claim. Here are other things you should know:

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
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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.
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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.
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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
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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.
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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,
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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.
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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.
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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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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.
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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.
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Kmjfree Nov 2022
So apparently my Dad contacted the company. He did not tell me that so I thought they had contacted him. He probably does not remember.
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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.
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Kmjfree avatar
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Kmjfree Nov 2022
No I have not contacted them directly yet. Still trying to get my hands on the policy so I know what’s in it. I don’t want to say the wrong thing and cause a delay. Also dealing with mother who is fighting against caregivers. If she won’t let them in the house there is no point in pursuing the issue.
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