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Valued Social Butterfly
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Re: LTC - Premium Increases Too Much? If You're Falling Consistently, Start a Claim

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The 'stop paying premiums when benefits start' is ONLY applicable IF there is a 'waiver of premiums' feature attached to the actual policy.  Some policies have this only when the beneficiary is institutionalized in a nursing home but not home-care.  Policies differ - one must understand their own individual policy - generalization should never be followed or assumed.

 

So, as always, one must review their own individual LTC policy before assuming anything.

 

 


* * * * It's Always Something . . . Roseanne Roseannadanna
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LTC - Premium Increases Too Much? If You're Falling Consistently, Start a Claim

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As with most long terms policies, when we started a claim, we didn't have pay the premium any more.

 

Here's how we started our LTC claim.  We first immediately reported my father's very first slip and  fall to a doctor in a face to face checkup visit. We told him about my father's dizziness and inability to walk steadily and that it's been happening for over a year.  We asked the doctor to order a Medicare approved walker. We had the doctor verify that my father's high blood pressure was causing dizziness and instability, and he verified it's a chronic condition.   We had him check for broken bones and bruises using X rays or MRIs. Then, we reported the next slip and fall a month later to the same doctor.  Again we asked him to check for bruises and broken bones and to give us pain medication for our bruises. Then on the third fall, another month later, we went to a different doctor and went  through the same checkup. Three months of falls, documented.  We documented all the doctor visits, and documented any prescription medications for high blood pressure, dizziness and pain.  Because my father is  basically home bound and have difficulty getting out of the house, we asked the doctor to send nurses and a physical therapist to the home, covered under Medicare's home health care benefit.  We documented those visits as well and collected the information, ready to give to the LTC company representative.

 

We reported to the  doctor that our  pain medication was causing further dizziness.

 

We document all of these doctor and physical therapy visits.  We called the LTC insurer to come out to the house for as assessment visit, we neglected to use the walker, and demonstrated our balance issue, and took the other tests, and we were approved for 20 hours per week of assistance.  As long as our claim is active, we owe no premium.

 

Remember, chronic, long term inability to walk or balance affects your ability to transfer from a chair, and it also affects your ability to toilet, and your ability to bathe.  That disability impacts at least three out of the five activities of daily living, and qualifies you for a long term claim.

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