It has become clear that my mother needs assisted living. She has a dementia and a MOCA score of 11 out of 30. This places are at moderate to severe cognitive decline. We are moving her into an assisted living facility and have placed a claim for a long-term healthcare insurance. It is a reimbursement policy that requires two ADLs or severe cognitive impairment, requiring substantial supervision by another person.
Here is my question. We are moving her in to AL but would like to give her a few weeks to acclimate to the facility before we start adding an extra things like bathing assistance. She will not be placed in memory care as she is not severely declined enough for that. Knowing those two things will my claim be denied? We will still be an assisted living receiving base level care which includes daily checks. Also, apparently assistance with taking medicine does not count as an ADL?
Finally, they kept saying something about she must incur a loss. I just assumed that if the cost of the AL was more than the monthly amount ($2K) they would send us the whole reimbursement amount, but will they only reimburse for the actual cost of care? (Not the cost of room and Board. I do not see any language distinguishing between the two R&B and Care in her policy.
Posted by Low_Ice_8855