Mom turns 75 on September 11, 2007.
Last year, Mom's health was failing fast and she was in and out of hospitals and nursing homes. Her confusion was pronounced and she was unable to remember to take medicine for serious diseases.
Her home was too much organization for her to maintain. She sometimes left the stove burner on. Her diet was mostly take-out and baked goods.
New York Life sent their representatives out to assess Mom.
Sadly, but not suprisingly, she finally qualified for benefits.
<- Mom and I, October '06, outside her houseIn March of 2007, thinking she was guaranteed of benefits for a lifetime once she qualified, she gave up her rights of survivorship to her house and gave most of it's contents to relatives. She moved into a small-but-nice, two room apartment in a new assisted living/nursing facility a few miles away.
She adjusted to life in the nursing residence and got three nutritious meals a day, nursing care for her diabetes four times a day, regular doses of her heart and blood pressure medicine, housekeeping, laundry, and new friends.
For that, she pays around $800 a month. Her insurance policy provided the rest.
She's tried to regain some independence and is proud of doing that. But she is unable to maintain any regime. She cannot drive nor cook.
She had resisted most attempts at help before. Now with the assistance she receives, her health can be a priority, and she takes better care of herself.
Mom, May '07, in her new apartment
Monday, August 27, she received a letter from New York Life. Someone, but not her doctor nor the staff at the home, has decided Mom doesn't need the benefit anymore and New York Life is terminating her benefits. They still want her to pay premiums though.
She is appealing to New York Life, with help from those of us who know she deserves the benefit.
Good luck, Mom!
I am appealing to all good people out there, especially Americans, to support major healthcare reforms to prevent insurance companies from making a profit off the weak, then hanging them out to dry.
I am appealing to Americans to consider what the right thing to do is and truly consider if how much money you make should have bearing on whether you're sick or well.
1 comment:
Candyjo,
I'm sorry to hear about your mother's situation. Here are some action steps you should consider taking:
1) Keep in mind that your mother's policy has not been cancelled. Long term care insurance policies cannot be cancelled, unless the premium isn't paid on time. While receiving benefits, the premiums cease. And, in most states, while receiving benefits, even if the premium is not paid, the policy still cannot be cancelled. Your mother's policy is still in-force, and she is still covered under the policy. The issue is a matter of claims adjudication, not that her policy has been cancelled.
2) You need to have the insurer, put in writing, exactly why they are not continuing to pay benefits. The two biggest areas of confusion regarding a long term care claim are whether the facility is a 'qualified facility' according to the policy; and whether or not the claimant is receiving 'qualified care'. Most states require a long term care insurer to put in writing (in a timely manner) why a claim is denied.
3) In regards to 'qualified care', most long term care insurance policies will pay benefits if the policyholder needs assistance with at least 2 Activities of Daily Living (e.g. bathing, dressing, eating, toileting, etc...) If the policyholder does not need assistance with 2 ADL's, benefits can still be received if the policyholder has a cognitive impairment and is a threat to herself or others.
4) It sounds like your mother initially qualified for benefits because of a cognitive impairment and she had become a threat to herself. Now, with proper medication management, it seems she may have improved.
5) I suggest you have the facility administrator, a geriatric care manager, and/or an attorney who specializes in insurance claims litigation, review your mother's current 'plan of care' and review her policy and see if they think she currently qualifies for benefits under the policy.
Your mother has rights under her policy and those rights can be enforced.
Scott A. Olson, CLTC
www.LTCInsuranceShopper.com
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