FRANKLIN MEDICAL CONSULTANTS P.C.
LTC VS. TLC page 69
Arthur Rose, M.D.,
Barry Moss, M.D.,
Leon Morris, D.O.,
and Sumner Camisa, M.D.
This isn't news to the Collins ,
family who were denibit their
claims because, according to their
LTC policy, they were supposed
to put Jenny's mother in a home
with a "custodial" license.
But not all areas use the same
terminology. In California, nurs-
ing home licenses use the words
"residential level 3" in place of
"custodial." The insurer finally
agreed to pay the claim only af-
ter months of legal fees, red tape
and aggravation.
The Gluck family was shocked
when their claim was denied af-
ter picking up the tab for the first
two months. Larry was admitted
to the second floor of a nursing
home for 51 days. After those two
months, he was transferred to
the first floor where he was more
mobile. Bad move. Somebody
should have checked with the in-
surer.
The A-rated insurance giant
suddenly refused to pay another
dime, claiming the switch in
rooms was actually a change in
care. The Glucks were rapidly de-
pleting what savings they had to
pay Larry's nursing home bills
while lawyers were seeking doc-
uments from the insurance giant.
Ten months later, the case was
settled and the Glucks were re-
imbursed half of the policy's en-
titled benefits, but they had to
pay thousands in legal fees.
COVERAGE
The policy must cover: pro-
longed physical illness or dis-
ability and cognitive disorders
like Alzheimer's senile dementia;
skilled nursing care, custodial
care and intermediate care; home
health care is a must; and nurs-
ing home care.
How much coverage is up to
you. A choice of daily benefits -
usually range from $50 to $250
per day for nursing home care.
It's important to know how much
facilities charge in your area.be. :
fore you select a benefit amount.
In 1995, Michigan nursing home
costs averaged between $100 and
$120 per day.
The length of the benefit peri-
od (how long the policy will pay
for care) is another consideration.
Most companies offer a variety
of benefits periods ranging from
one to five years to unlimited.
The premium is higher the
longer the benefit period you se-
lect.
a-day coverage for three years
and need to spend only $50 a day
for home-health care visits, your
coverage will last twice as long
as originally intended. Check the
fine print!
What's not covered in LTC
policies and won't be paid for is
care related to mental and ner-
vous disorders and diseases, oth-
er than Alzheimer's; alcoholism
and drug addiction; illnesses
caused by an act of war; treat-
ment already paid for by the gov-
ernment; attempted suicide or
intentionally self-inflicted in-
juries.
You must know what your
agent means when they use
these terms: Alternate plan of
care, a rider that can mean any-
thing from the right to negotiate
a new premium to having a
wheelchair. Don't give your in-
surer that much freedom. Make
sure the insurance company
spells out exactly what benefits
its going to pay for if you accept
this rider.
Protection
or a waste?
Examples include: payment
for durable medical equipment
(devices) that let you stay at-
home, and capital improvements
to your home, like wheelchair ac-
cess ramps or grab bars.
Assisted living are apartments
where an on-staff nurse comes in
to help with meals and baths.
These are a popular choice
among the more independent.
Read the fine print carefully!
Some policies pay only if the pol-
icyholder is living in a group
home. Policies are designed to
guarantee your privacy. Make
sure you get it!
Residential care is similar to
assisted living, but policies often
pay just for Alzheimer's patients
in a homelike setting. To quali-
fy for coverage, patients usually
need help, eating, bathing, or
dressing.
TERMINOLOGY
Inflation riders are recom-
mended by most states' insur-
ance watchdogs for younger
policy-holders. These add-ons in-
crease the amount of benefits to
cover inflation. Most 45 year olds
should benefit. For the average
65 year old, the rider increases
PAYMENTS
the
annual premium by 62 per-
Most new policies reimburse
your expenses out of a maximum cent.
Nonforfeiture benefit. If you're
total pool of funds based on your
40,
consider taking it, but pass if
daily coverage limits multiplied you're
much older. This rider lets
by the term of your policy.
collect part of your paid pre-
That "pool of funds" concept you
if you cancel the policy af-
may allow you to be reimbursed miums
ter,20 years. For a 65 year old, it
for actual expenses up to your increases the annual premium
daily limit. And if you choose less
39 percent.
expensive care, the additional by Trigger.
A qualification in the
funds can be used to extend the
care period.
LTC VS. TLC page 72
For example: if you buy $100-
is pleased to announce the association of
Kwan Yee, M.D.
to their internal medicine practice
The doctors offer complete care for adults:
■
■
■
■
routine and urgent care
annual physical exams
preventive medical care
comprehensive diagnostic testing
The physicians are all certified by the
American Board of Internal Medicine, on staff
at William Beaumont Hospital in Royal Oak
and participate with most insurance plans.
Kwan Yee, M.D., is
a graduate of Wayne
State University School
of Medicine in Detroit.
He completed his
residency in internal
medicine at
William Beaumont
Hospital in Royal Oak.
Call now for an appointment!
(248) 355-3033
29275 Northwestern Hwy.,
Suite 200, Southfield
(north of 12 Mile Rd.)
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