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Re: LTC claim for Huntington's Disease patient

Posted by Nathan Stec on April 12, 2002 at 12:29:12:

In Reply to: LTC claim for Huntington's Disease patient posted by Jim on April 11, 2002 at 11:14:20:

: We purchased LTC ins. for my wife before her diagnosis of Huntington's Disease. When she could no longer function in the home, she moved to and Assited Living Center. I recently filed a claim and John Hancock denied it, saying she did not satisfy the ADL rules or cognitive requirements. HD is a unique condition. There are published HD ADL rules but I don't know if they have been used as a basis for a claim. I will appeal their denial but it looks like they need to be open to a different scale. Any thoughts?

When did you buy your Hancock policy? What is your wife's health situation? Does she need help eating, bathing, dressing, transferring from her bed to a chair, toileting, or maintaining continence? Has she taken the standardized memory tests your doctor has administered? Why did she need to go into the ALF?

The reason that I'm asking is that Long-term care insurance is not meant for people who want to go into an ALF for convenience reasons, you definitely must qualify for the care. If she does not qualify to need care now you will not be able to use your plan until her condition worsens. If, however, she needs help (someone within arm's length while she's doing 2 of 6 ADL's) she should qualify.

If your wife does truly need care, hopefully Hancock will stand next to its policy.

Follow Ups:

Re: LTC claim for Huntington's Disease patient Nathan Stec 12:36:06 04/12/02 (1)
- Re: LTC claim for Huntington's Disease patient Jim 10:57:33 04/15/02 (0)

Re: LTC claim for Huntington's Disease patient : : We purchased LTC ins. for my wife before her diagnosis of Huntington's Disease. When she could no longer function in the home, she moved to and Assited Living Center. I recently filed a claim and John Hancock denied it, saying she did not satisfy the ADL rules or cognitive requirements. HD is a unique condition. There are published HD ADL rules but I don't know if they have been used as a basis for a claim. I will appeal their denial but it looks like they need to be open to a different scale. Any thoughts? : When did you buy your Hancock policy? What is your wife's health situation? Does she need help eating, bathing, dressing, transferring from her bed to a chair, toileting, or maintaining continence? Has she taken the standardized memory tests your doctor has administered? Why did she need to go into the ALF? : The reason that I'm asking is that Long-term care insurance is not meant for people who want to go into an ALF for convenience reasons, you definitely must qualify for the care. If she does not qualify to need care now you will not be able to use your plan until her condition worsens. If, however, she needs help (someone within arm's length while she's doing 2 of 6 ADL's) she should qualify. : If your wife does truly need care, hopefully Hancock will stand next to its policy.

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