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Old 05-31-2011, 07:39 AM   #41
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A change of address to Hawaii raises a potential state tax liability or health care law regulation issues. The concern about the facility not forwarding promptly is legit. A change of address to the designated POA works best. Some financial institutions allow duplicate statements to be mailed to a different address, but not health care or gov't. Until he has a permanent address, I would use the brother with the POA.
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Old 05-31-2011, 09:32 AM   #42
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A few things no one has mentioned yet:
1) Safe Deposit Box....when I took over my FIL's affairs we looked in his box, and found several matured $5000 muni bonds. Took 9 months to collect via Schwab.
2) ADLs will continue to be important after the LTC runs out. The IRS allows medical deductions for care, but not for living expenses. Fortunately, the facility billed separately for the room and board.
3) Theft is an issue in all of these facilities. Not just money, but anything valuable can disappear. Jewelry, IPOD's etc.
4) To reaffirm one thing that was said earlier, as screwy as it seems, some states require a trustee or conservator to follow "Modern Portfolio Theory". In CA, this meant that we had to get an hourly CFA to write a letter with the AA included to put the file as a CYA and or submit if requested.

Alz. cannot be diagnosed at present without an autopsy. The fact that both long and short term memory are impacted might suggest another cause for the dementia. There are at least 7 known causes. This might be important because the progression is different.

Finally, it is important to have some doctor examining all the drugs and their interactions. My father was given some things that conflicted resulting in a temporary crazy spell during which he whacked a care giver. When the drug thing was fixed he was back to normal, but had a forever after "possible violent" label attached making finding a residence difficult.
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Old 05-31-2011, 09:58 AM   #43
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Nords, I hope your father continues to be comfortable and I think you and your brother are doing a wonderful job of taking care of his affairs. Your dad is a lucky man to have sons like you!!
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Old 07-17-2011, 03:15 PM   #44
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This is all going to work out eventually, but it's turning into a marathon instead of a 400-meter heat. I'd appreciate any advice from those who've had to work through the system with their loved ones.

John Hancock is grumbling about turning down the claim.

Three months ago when I filed the claim, I was given the number of supervisor "Mary" who explained the process. She advised calling her only when I had more than a basic question. So now when I call the 1-800 number I get claims service. As my questions are asked, I might get transferred to clinical services or policy services. Over the last month those "services" have started giving conflicting info or answers like "Gee, I don't know why this hasn't been approved". So I finally called Mary.

Last Friday Mary said that Hancock "might not be able" to approve the claim. She says a typical care center's Medicare code information provided on the claim form (UB-04) is usually fairly pessimistic, even dire. They want things to look as bad as possible so that Medicare will pay them. Yet Dad's UB-04 is not considered bad enough to cover three of the six ADLs. The "help" he gets bathing & dressing is more supervisory, not assistive.

The "minimum data set" (MDS, https://www.cms.gov/IdentifiableData...DataSetMDS.asp) and "mini-mental state exam" (MMSE, What is the Mini Mental Status Examination (MMSE) for Alzheimer’s Disease?) are two other claim forms. Again according to the first he isn't in bad enough shape, and according to the second his memory's too good. Part of the MMSE is giving the subject three words to remember. They're asked to recite them. A few minutes after that they're asked to recite them again. Dad got all three. For cognition to be considered "impaired", even getting two correct is borderline.

Yet from everything I read on the Internet, and from the time I spent with Dad in the hospital (admittedly not at his best), and from my brother's frequent visits, and even from a letter Dad surprisingly wrote us last week: his cognition is absolutely impaired. He can't "get through the day". Even if he was set up in another apartment with daily visitors, his nutrition and socialization would quickly go off a cliff-- again. If he left his lodgings then he wouldn't be able to find his way back. Even worse, he'd try to drive a vehicle. He spent nearly 30 years in a nuclear engineer's sales job, selling nuclear plants to utility companies by explaining very complex concepts to business people. He's disarmingly charming, polite, agreeable, and able to bluff his way through any conversation. It took our lawyer nearly 30 minutes to realize that (regrettably) Dad's not mentally capable of agreeing to a financial POA. The MMSE exam is superficial enough to assess most of the subjects, but in this case it's not detailed/long enough to really determine that Dad can't handle his affairs.

Mary says the claim hasn't been denied-- yet. She says that the tests are shortened versions of full-blown (expensive) tests, and the short versions don't always capture the full story. She said that Dad's declining weight could be interpreted as another symptom of impaired cognition. (It's a symptom, although researchers don't seem to understand why.) She said that if he's on certain medications (blood pressure?) then needing supervision to take them might indicate inability to handle another activity of daily living. So next week I'll be spending a few more hours on the phone querying the care facility on the trivia of ADLs and medications.

Mary said she'd ask her supervisor to pay for a more detailed onsite assessment, which is not normally approved. While she's doing that, she advised that we line up a neurologist (not "just" a psychologist) for a neuropsych evaluation.

Even if this drags out for another month or two, the good news is that Hancock will pay retroactive to the 100-day exclusion period (which ended 15 July). If Dad ends up in a hospital for some other crisis, though, that kicks off another round of Medicare eligibility which would be followed by skilled nursing rehab and another 100-day exclusion period. At $214/day, these expenses add up.

I'm concerned that Hancock doesn't seem to have a clear-cut end to the claims process. If this does drag out for another month or two with no definitive answer, then I don't want to be accused of not properly submitting a claim or not processing it quickly enough. I guess I'd rather have a faster "Sorry, no" followed by a statement of what needs to happen before it can be resubmitted, plus an explanation of the appeals process. But I suspect I'll get that "Sorry, no" answer within the next couple weeks.

So I called our geriatric care manager for a neurology appointment and alerted my brother that he might have to drive Dad to the appointment. (Which upsets Dad like a young child getting lost at the shopping mall.) I asked our lawyer to hustle up on the guardianship/conservatorship petition and her own psychologist's mini-mental state exam (part of the petition). And while we're waiting, I guess we're also going to pay another month or two of long-term care expenses out of Dad's assets.

Ironically, Hancock's policy-services call center affirmed that the policy's 20-year 5% inflation rider is still accruing for another 18 months. (Or until the claim starts paying out.) So for every month that they won't pay their current $240/day limit, it rises by another daily buck or so. Yet the claims supervisor says that the onsite assessment is usually considered too expensive to be approved. I pointed out this financial inconsistency and was told that the medical criteria are considered more important than the financial ones. Riiiight.

Mary said that Hancock administers thousands of policies, from dozens of companies bought by Hancock over the years, with many different forms of coverage. She said that I wouldn't always get consistent or correct answers from the call center. I said that sort of advice would just encourage me to call only her from now on.

Frankly (even without the long-term care insurance) Dad's pension, SS, and savings will probably last longer than he does. But it's disheartening to have the finish line jerked out from under your feet-- and to be told that he's going to have to pony up more thousands of bucks to "prove" what you already know.
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Old 07-17-2011, 03:54 PM   #45
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Do you have a copy of your Dad's LTC policy? If not, get one.

Make a list of the requirements for benefits and original date of the policy.

My recollection is that your father lives in CO and probably purchased the policy in CO. Call the CO Insurance Commissioner's office for information on their expectations of time-frames for response from Hancock. You might ask them also for any regulations that define 'assistance' with ADLs.

Send a letter to Hancock asking them, based on those contractual requirements, which ones your father meets or hasn't met based on documentation they have received. I would give them a reasonable drop-dead date to respond that lines up with state requirements. Start developing a paper trail.

With that you know what documentation you might need to resolve this matter.

My parent's policy was with GE but it was old and didn't pay out much. Maybe that is why they didn't give us grief when applying for benefits.
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Old 07-17-2011, 04:04 PM   #46
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The lack of a denial is telling. It sounds like Hancock does have a clear cut goal - this is one way an organization says "no" without saying "no". They probably do have thousands of different policies, but that's not your problem, regardless of how hard they try to make it so. Most financial institutions are not subject to penalties for this type of behaviour, and there are people that give up and walk away.

You might contact the facility administration where your father is to discuss this with them. A face to face meeting usually works, perhaps your brother can arrange one with your help which you can then follow up on by phone. Ask what experience they have with Hancock that may apply to your situation. There is no doubt this is an issue they deal with (probably frequently) and unless there is something specific in his policy that is unique, they should be able to tell you if it covers his care now. In fact, if it were clearly a problem they probably would have let you know when he was first admitted. Even if his coverage is not clear cut, they may help to find a way to reassess so that he meets the required criteria. The people in the administrative office probably know exactly what is needed to qualify and the physician overseeing his care should be able to assist.

If the facility supports your claim, escalating within Hancock may be required. If there is a claims window deadline, a letter documenting the contacts so far is advisable just to establish that timelines have been met.
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Old 07-17-2011, 04:43 PM   #47
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Definately contact the state insurance department and get what information you can. I would also find out how you go about filing an official complaint with the department so that you know how to make it stick if it comes to that.
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Old 07-17-2011, 05:41 PM   #48
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My office manager said that her DH had to contact a lawyer, when her MIL's LTC was denied. It was approved then.

Some one should file to be Representative Payee for his social security benefits. If something as simple as a letter is returned, his SSA record will be put in suspense (checks stopped).

Good luck with everything and I agree that your father is lucky to have such caring sons.
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Old 07-18-2011, 12:31 AM   #49
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I'm starting all those steps this week, especially if they drag their feet on the independent assessment. It's possible that Hancock will come up with a better answer when they have time to talk amongst themselves.

The claims staff need to understand what type of advocate they're dealing with. I suspect that they get a lot of overworked, stressed-out people who haven't had the time to educate themselves and are just trying to juggle family responsibilities. OTOH I have plenty of time and a fair amount of financial resources to devote to this. Eventually some CPA is going to look at the ammunition piled up on both sides of the situation and realize that approving the claim is cheaper than litigation.
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Old 07-18-2011, 05:22 AM   #50
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Eventually some CPA is going to look at the ammunition piled up on both sides of the situation and realize that approving the claim is cheaper than litigation.
When I was helping to sort out my grandfathers estate (My grandmother, with dementia, was swindled by the former trust officer of the Church that handled the estate) I used a similar tactic. I one point I mentioned that I was retired, independently wealthy, and my best friend was litigation attorney. It got a bit of attention, although ultimately we ended up hiring attorney and suing.


Best of luck.
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Old 07-18-2011, 09:05 AM   #51
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The claims staff need to understand what type of advocate they're dealing with. I suspect that they get a lot of overworked, stressed-out people who haven't had the time to educate themselves and are just trying to juggle family responsibilities. OTOH I have plenty of time and a fair amount of financial resources to devote to this. Eventually some CPA is going to look at the ammunition piled up on both sides of the situation and realize that approving the claim is cheaper than litigation.
FWIW my experience shows this makes all the difference. The time and resources along with the know-how, attention to detail and excellent record keeping.
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Old 07-18-2011, 10:38 AM   #52
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I think I see Nords's next book's focus. Watch out, LTC companies!

Your father is a lucky man to have you delving into this, Nords.
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Old 07-18-2011, 10:42 AM   #53
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When it became obvious to everyone except my mother that she could not stay alone in her home any longer because of her dementia, I made arrangements with a highly recommended, nearby assisted living facility. They told me that if I could get her to the facility, they would be sure she stayed there. So, when my mother had a weak moment, I carried her to the ALF. I know this is the very thing that old folks fear, but there comes a time when there is no choice and my mother soon forgot that she had ever been any place else. As soon as she was there, the ALF made arrangements for an evaluation with a Big City Hospital which had a geriatric psychiatry unit. She was at the hospital for two weeks. Medicare paid. After the evaluation was prepared, my mother's LTC company (Conseco) did not question whether she was eligilble for benefits. Conseco paid for four years until her benefit ran out. Then she went on the pay-through-the-nose plan. Fortunately (?), she died before her estate was exhausted.

As a separate issue, when I sold her house, I discovered that my POA was worthless. I had to be granted a conservatorship by the chancery court in the proper jurisdiction.

This thread is frightening because DW and I have our LTC policies with John Hancock. Previously, I thought that Conseco had to be the world's sorriest LTC company.
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Old 07-18-2011, 01:59 PM   #54
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Nords, I wish you the best of luck in dealing with this.

My mother had a similar situation when she tried to make a claim on her LTC insurance (before her death, naturally). She tried and tried and couldn't do it. I don't remember if they denied her claim or just procrastinated as in your case, but basically it had been more than long enough and nothing was happening.

Finally, my brother and her grandson (the hotshot NYC attorney) got involved and after a great deal of time and aggravation, they finally managed to fix the situation. She would have received nothing she not had two such capable advocates willing to spend many hours of time dealing with this mess. I have heard other similar stories.
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Old 07-18-2011, 02:20 PM   #55
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I have heard other similar stories.
The next time the question comes up of whether to buy a LTC policy, I hope someone remembers to refer back to this chronicle. For want of anything constructive to say, I'll just remark that it's practically inevitable that it would work this way. If there is any possibility of avoiding paying a benefit, or delaying it, the insurance company's response is predictable -- any benefit is money out of their pocket.
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Old 07-19-2011, 01:49 PM   #56
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My parents did not have LTCi so all LTC (including NH for father) was paid out of pocket.


Not sure what is going on at JH. But a few thoughts.

  1. As the supervisor or claims analyst described... call center people don't know zip... other than the answers to common questions. They are often just a glorified answering service with FAQs. Complex questions that require judgement are always dealt with by specialists. If there is ever any major issues do not delay (waste time)... if you do not get satisfaction immediately, escalate the situation to someone at a higher level and get resolution or a time when they will get back to you on it (follow-up with you). That should keep the issue in work (if it is not resolved).
  2. They are not going to approve it unless your father meets the criteria.... or there is some extenuating circumstance or rule that dictates overriding the general rule for ADLs. You need to expedite the more thorough testing. Bottom line, every month they do not pay is a month of benefit they keep.
  3. I suspect that JH will pay eventually... It is just a matter of time before your father will meet their criteria. The problem may be that you might end up having him tested a few times.

If you father is borderline.... that may be the issue. Often, a spouse (sometimes another family member) will keep the person home and care for them until they can no longer deal with it. Sometimes they augment the help by bring someone into the home or using adult daycare for awhile. By the time the person with the illness goes to a care facility, the illness is undeniable.


Expect the unexpected! Expect complications and difficulties. Otherwise, it will be rough on your psyche. Nothing about this is going to be simple or easy.... emotionally or task wise!

Hang in there and be patient (so it doesn't drive you crazy).
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Old 07-20-2011, 12:08 PM   #57
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Unfortunately my brother's been beating himself up for not spending more time with Dad over the last 20 years... despite my brother running his own business and having to drive a 500-mile round trip to visit, let alone never getting any reciprocating visits from Dad. I guess being "on the scene" with Dad is his way of personal atonement.
My brother never married nor left home. Mom died of breast cancer early and then Dad spent 30 years living with bro. Both of them would have preferred to live separately but stayed together out of convenience.

In his final years, Dad became increasingly ornery. Bro used to leave the house for long periods to maintain his sanity. On one such trip, Dad fell and broke his hip. Bro wanted to beat himself up for not being there. I said "no way. You were there for him in so many ways!" but it was a tough sell.

What you might do is thank your brother regularly with gift certificates (books if he likes those, or meals if that is better, etc.). This cost is minor compared to the greater cause.
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Old 07-21-2011, 04:29 PM   #58
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Some progress yesterday-- literally "Whaddya DO all day". Even if it's only banging away on a keyboard and talking on the phone, it feels better than waiting for people to call and trash my optimism.

After four months with minimal detectable progress on our guardianship & conservatorship petitions, our lawyer said that she'd been led on & stood up by her usual psych consultant. (Really? How's that feel, eh?) She called a new psychologist who's interviewing Dad next week. She'll have his report by early August, she'll file the petitions by mid-August, and we should have the court appearance in late September.

The lawyer earns $275/hour and we're already over $1800 of e-mails, phone conferences, and interviews. But the real value is in knowing how to get things done and who to call to do it.

The psychologist earns $250/hour. His evaluation will first be used for the guardianship & conservatorship petitions, and then will probably bolster our long-term insurance claim. His fee is estimated to be around $2000-$2500.

This psychologist is doing a 30-60 minute "functional assessment" to charm Dad into demonstrating various tasks like making a phone call, writing a check, or cooking a meal. The doc understands that people can put up a good first impression so somehow he's going to engage Dad long enough to get past the facade and see how impaired his cognition really is. This evaluation is usually more than enough justification for the probate judge to approve the petitions (especially when the family's working together). But if the psychologist (and perhaps the lawyer) don't persuade Hancock that Dad's symptoms meet the terms of the LTC policy, then we'd have to step up to the neurologist. I bet neurologists earn more than lawyers or psychologists.

These professionals are worth every penny for the legal authority to keep Dad safe, even if he may someday feel otherwise. They're worth every penny on a ~$300K LTC claim. It's not worth haggling over $275/hour for a few days' work (plus client education) when you're paying at least $214/day at the care facility for years.

Of course at $250/hour I want to make sure these pros are adequately briefed and prepped. I sent the psychologist a four-page bio of Dad and his latest behavior/concerns, along with PDF scans of his last five letters (three years) showing how they've degraded. Hopefully the doc understands Dad's references to certain 1960s events or people and doesn't need 30 minutes just to realize that he's getting fooled by a really good first impression. Perhaps the doc has been around long enough to have seen all this before.

It turns out that Dad's on Lisinopril for blood pressure, so taking medication properly would impact one more ADL. (I can't tell whether Hancock's aware of that medication.) Oddly enough when Dad started his BP treatment three years ago the Lisinopril knocked him for a loop-- two weeks of nausea & narcolepsy before he gave up and asked the doc to try something else. Dad's been on Fosinopril since then until he was hospitalized. Maybe the latest Lisinopril dose is different or maybe his physiology has changed.

In the meantime the care facility helped me sort out the latest billing status so that I could send them another $10K to keep them going for another six weeks. (Hancock may reimburse this.) I may have also persuaded the care facility to help me break Dad's apartment lease by printing my draft text on their letterhead as a medical excuse. That would save us another $4500 over the lease's remaining six months, so I'm happy to pay the care facility's fees (if any). So far the care facility has been the best part of this whole experience.

My brother finished cleaning out Dad's apartment last weekend. It could've been a lot worse-- only two bedrooms and no hoarding behavior. Two truckloads to Goodwill and a big yard/Craigslist sale. He brought home a couple antiques and a stamp/coin collection to appraise. He's finished sorting all the files & memorabilia and says two boxes (three cubic feet each) should arrive here in Hawaii this week. (I'm glad he saved me a Mainland trip!) I've canceled nearly all the utilities and Dad's personal-property insurance but the electric/gas will have to wait until the property manager agrees to break the lease. Dad's mailbox was totally empty, so apparently we've been getting all the mail that's been sent to him.

I called Dad's neighbor to thank him once again for keeping an eye on everything. This is the guy who lived next door for over two years but only met Dad once. Matt was coming home from work at 11:30 PM Saturday night to encounter Dad staggering down the steps in pain from his ulcer-- getting ready to drive himself to the hospital. Matt saved more than one life on the road that night by driving Dad to the ER.

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What you might do is thank your brother regularly with gift certificates (books if he likes those, or meals if that is better, etc.). This cost is minor compared to the greater cause.
I think my brother and I each feel that our division of labor is giving each of us 65% of the benefits...
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Old 07-22-2011, 03:10 PM   #59
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...I think my brother and I each feel that our division of labor is giving each of us 65% of the benefits...
yes it sounds like it. Good progress! Let's hope all goes well...
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Old 07-23-2011, 01:06 PM   #60
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Another aspect.

I don't know how interested you are in protecting your Dad's assets long-term from nursing home payments such that Medicaid starts picking up the costs. If you are, you should get all of your Dad's assets out of his name and into the name(s) of others ASAP. I'd presume that would be in his children's names assuming they are the beneficiaries of his estate/will/trusts. Last I checked, Medicaid can "look-back" five years to see what assets were transferred out of his name. Net, if had nothing 5 years ago; i.e., in five years from now they look back to today, Medicaid then need to pick up the nursing home tab less his income - SS & pension. You could leave enough in his name such that when the LTC is gone in three years, there's enough in his name to pay the nursing home balance for 2 more years.
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