If I ever manage to get the LTC carrier to start paying for home care and if my mother lives a long time, then she will be ahead, but for now, it is incredibly frustrating trying to get the LTC carrier to approve provided care so that it can count toward the policy elimination period.
My mother’s policy has a 100 day elimination period, but in order to satisfy the elimination period, one has to submit documentation of licensed care provided, and then the LTC carrier has to approve that the care meets their definition. All this, even after their nurse approved my mother as needing in-home care.
Obtaining and submitting the documentation is trying, at best. The aspect I find most annoying is the carrier’s request for documentation of the exact same care they have already approved. For example: in-home PT claims approved for Jan & Feb still requires full submission of all care notes for March & April visits from the same provider for the same services…even after LTC nurse approved benefits. Carrier will not accept Medicare EOBs.
Self-funding of care would remove a lot of the hassle, but I recognize that the plan could pay significant benefits if the patient manages to live a long time with a condition that satisfies the LTC carrier’s definition of need.