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The Fine Print One of the big reasons people buy long-term care insurance is to avoid burdening a spouse or grown children when they can no longer care for themselves. But some family members are shouldering another type of burden: It was an incredible amount of work. Havlish, a former nurse who now works as a life coach in Boulder, Colo.
Later, she had to follow up continually with the aides and doctors to make sure they were filing the proper paperwork so that they insurer would pay. In other cases, families have had to fight to overturn denials, and have gone as far as hiring lawyers to file suit.
Many Americans now in their 80s and 90s who are collecting benefits — or trying to — bought their policies decades ago when the policies were more restrictive than now.
On top of that, many insurers have since left the business after mispricing the policies and failing to judge the economics of the industry, which has made collecting payments even more difficult. And clearly, claims worth billions are paid each year: An estimatedpeople received long-term care benefits at the end ofaccording to Mr.
If you need to file a claim on behalf of a loved one, it helps to know why claims are denied and where filers tend to get tripped up.
The policies have waiting periods, or elimination periods, and they are typically measured in days: But the way the waiting periods are counted is critical, too. This applies to certain policies written after And then the insurer may deny the claims.
Kantor, a lawyer in California whose firm focuses on insurance claims, said he represented a woman, blind from severe macular degeneration who was receiving benefits for home care. But when the representative from the insurer asked her if she could bathe by herself, the woman told the company she could as long as her aide led her into the shower and gave her soap and a washcloth.
Shortly thereafter, the insurer cut off her payments. The insurance company settled, but the terms were confidential so Mr. Kantor could not divulge the insurer or the exact amount it paid.
In California, for instance, the state insurance law prohibits insurers from imposing this requirement, Mr. Gordon said that many carriers could still pay for assisted-living facilities as long as they met certain conditions, including being licensed by the state, providing care by a licensed doctor and hour nursing services, among other items.
Even once you think you have found the right type of facility, be sure to read the fine print. Some policies will require that a facility have a nurse on duty 24 hours a day.
Slome, of the trade organization, said that many insurers did not anticipate the new types of facilities. But since the CNA unit stopped selling the policies inhe said they were making a habit of no longer honoring those provisions.About Home Care Services. Although most home care is provided by family, friends or volunteers, there is a growing trend to hire paid individuals or professionals to provide this care in the home.
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