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Starting LTC Policy?
Sleepless in Sleep
Posted: Wednesday, February 16, 2022 10:44 PM
Joined: 10/13/2020
Posts: 15


Thankfully my parent bought a LTC policy, and it is about time to ‘start’ it.

My question(s) about this are related to any pitfalls once you ‘call’ the company. My parent has a few accounts (annuity, life, investment) with the same company. I also have some dealings with them.

I have broad Durable POA, and my parent has an unfunded trust (both will be news to the LTC company). I am a little ‘scared’ about doing this.

My parent lives in my home and hasn’t been a financial burden. Unfortunately, they will require a more professional environment soon, and that is when I’d like to begin using the policy (it won’t cover everything, and it is not unlimited). I fear that when we call about the LTC policy all future dealings with this company will become difficult. Does anyone have experience with this? I just don’t want to have to battle about this; I’m already worn-down with decisions.

The company is reputable: Northwestern Mutual.

Thanks.

Edit: this is more about the structure (pitfalls) of initiating the policy, not the policy coverage and details. That gets more complicated and can be addressed separately.


Victoria2020
Posted: Thursday, February 17, 2022 12:55 AM
Joined: 9/21/2017
Posts: 1233


I'd talk to your Elder law attorney about all these issues then proceed.

 Also, an unfunded trust is like an empty envelope with a name scribbled on it  - what assets should be in it?

 


Stuck in the middle
Posted: Thursday, February 17, 2022 6:48 AM
Joined: 6/4/2017
Posts: 1850


I don't think your dealings with Northwest Mutual will become more difficult when you claim benefits from the LTC policy.  The people working in the LTC department probably don't even know the investment people.  Also, they are just doing their jobs.  It's not their money you are claiming.  I spent most of 50 years in the Social Security Administration, authorized payment of millions of dollars per year, and my only concern was to pay the money in the way the law (policy, to NW Mutual) specified.
SusanB-dil
Posted: Thursday, February 17, 2022 7:31 AM
Joined: 9/10/2021
Posts: 271


Hi Sleepless -  MIL has LTC policy.  They just don't like to pay out. It has nothing to do with any of her other assets.  Her policy also has limitations, and we just wanted to start using some of it to pay our daily caregiver more than we can afford to out-of-pocket.  and this caregiver is SO worth it - she's been a blessing!   (She lost her job due to pandemic and is looking for another job - it would help if we could really 'pay' her, rather than just 'hold her over for now')  We also wanted to be able to have back-up in the event our care-person needed any time off.

Called the insurance company, and they had a nurse call us to do an assessment over the phone.  They asked us if she could do this and that, and then asked her a few cognitive questions, such as date.  She picked up the calendar and looked at it to answer them.  They have refused to help at this time because they said 'she (mil) is still very independent'.  Really?  Seriously??  

PrimCare doc and neurologist have both stated she cannot be left alone. We know she cannot be left alone.  But the insurance company.... 'she's very independent'...  ???   because she can feed and dress herself yet.  She cannot fix a meal, and she will wear the same clothing a day or two, and would wear longer if we didn't make her change the clothing, she does not know what day it is even if she looks at said calendar, which is even unusual, she is a fall-risk...  etc etc...   Just frustrating to deal with them.  Hope it goes better for you.


Victoria2020
Posted: Thursday, February 17, 2022 8:12 AM
Joined: 9/21/2017
Posts: 1233


If you're claim is denied you'd want to look for a lawyer who does long term care insurance lawsuits. Insurance is mainly  state regulated so it would be the state where the PWD lives.

If they'll do it, it may be worth a few hours billing to have them review the policy and help you honestly frame the answers to correctly reflect the issues but not give the insurance company something to trigger delays , extra exams etc.

I  don't regret not buying the coverage , you can pay and pay premiums and then they can raise rates beyond reason or if they have a very unprofitable book of business they can just turn in that insurance company's license, but their corporate holding entity goes on.

 


Rivay
Posted: Tuesday, May 10, 2022 10:09 AM
Joined: 5/10/2022
Posts: 1


Hi Susan,  

I want to follow-up on your post regarding getting a LTC claim declined.  I hope you were able to ultimately activate the claim.  My mother is in the very same situation as you describe, unable to remember dates, locations, prepare meals, figure out clothing, and can't be left alone.  However, she was also declined coverage on our first round.

I am getting more involved and trying to figure out how to position our claim, given her issues are cognitive in nature it seems more of an uphill battle.  Any guidance or information you can provide on steps you have taken will be much appreciated.


SusanB-dil
Posted: Tuesday, May 10, 2022 2:16 PM
Joined: 9/10/2021
Posts: 271


Hi Rivay - and welcome to 'here'...  We have not fought to start the claim.  We finally found the paper they sent that MIL hid. 

Per the insurance people and the way her policy reads: She has to 'not be able to do three ADL's ' (Activities of Daily Living) before they will allow any activation. Per her policy (other policies may differ):  personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating.

She has some issues with each of these activities, but can kind of manage. sort of. not very well.  maybe some things better than others...  some maybe a little better, anyway. Ok - hard to explain it all, except that a lot of these posts indicate a lot of folks totally understand.


mommyandme (m&m)
Posted: Tuesday, May 10, 2022 2:44 PM
Joined: 2/16/2020
Posts: 533


My moms LTC policy with John Hancock was initiated a few years ago.  She had to pay a few months out of pocket first and had to have a doctors diagnosis of Moderate stage dementia to receive the benefits.  

As far as in-home caregivers, they require licensing for the most part.  A licensed home care company or a licensed HHA, CNA or higher.  They won’t pay just anyone and even though I’m a licensed CNA they won’t pay me as I’m considered an immediate family member even though we technically live in separate dwellings.  Of course a MC or SNF would  also have coverage benefits.  I send in all the claims and paperwork to get things taken care of alongside  my bro.  

I wouldn’t worry about muddying the waters due to her other assets with the company. As a client she paid insurance premiums without those assets being involved, it’s a separate entity.  A billionaire could buy insurance coverage and their billions wouldn’t affect their insurance payout.  

I’m so thankful mom planned for her elder care legally and financially while totally cognizant. 

Good luck. 


SusanB-dil
Posted: Tuesday, May 10, 2022 3:44 PM
Joined: 9/10/2021
Posts: 271


do check the policy, you could even check with Northwestern Mutual if you need help with it... MIL's would let us pay for our choice (not necessarily licensed), but it cannot be family.  Upon further decline, I have no doubt we will need more professional care.  For now, we are fortunate and blessed to have the caregiver we do. She meets and exceeds our needs - for now.  

 


Sleepless in Sleep
Posted: Tuesday, May 10, 2022 11:25 PM
Joined: 10/13/2020
Posts: 15


I saw this topic pop back up. Quick update.

Northwestern Mutual activated the policy and we are currently in the elimination period.

This was done quickly based on the independent assessment (zoom meeting) and records from the neurologist. 

I’d say we are currently stage 6b (6c’ish), and the insurance company has been very helpful so far. It doesn’t cover everything, but I am thankful the help it will provide.


JJAz
Posted: Sunday, May 15, 2022 1:38 AM
Joined: 10/21/2016
Posts: 2780


READ the policy and then talk to the agent.  After you have a good sense as to the policy requirements, then call the company.  They will assess your parent/s and tell you the benefits.  Then you can decide if you agree or need to protest.  Good luck.
mommyandme (m&m)
Posted: Sunday, May 15, 2022 2:20 PM
Joined: 2/16/2020
Posts: 533


Sleepless,

Thanks for the update!


 
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