As Long Term Care Insurance Claims for Alzheimer’s Increase, So Will Denials of Benefits

Recently, we’ve been surprised by the number of calls from people denied long-term care insurance to pay for care from Alzheimer’s disease. Once a policyholder receives an Alzheimer’s diagnosis, or at least begins suffering from the dementia typically associated with the disease, arguments about whether or not the person needed institutional or in-home care seemed irrational. Then we read about the latest survey conducted by the American Association for Long-Term Care Insurance and those calls began to make sense. See “Alzheimer’s Disease Is Top Long-Term Care Insurance Claim.”

According to the survey, one out of every four long-term care claims paid to nursing homes is for Alzheimer’s care.”Americans will pay an estimated $200 billion for care received by individuals with Alzheimer’s,” explained Jesse Slome, executive director of the American Association for Long-Term Care Insurance, in a press release about the survey. “Insurance is increasingly being used to pay for care and Alzheimer’s is the top cause of claims for those in nursing homes. Last year long term care insurers paid out $6.6 billion in claims to over 200,000 Americans.”

As Long Term Care Insurance companies pay more claims for Alzheimer’s – perhaps more than they anticipated when they begin selling the policies – they are likely scrutinizing the claims more rigorously. That means claims that may not have full documentation or inadequate explanations are likely being denied for reasons that seem unfathomable for policyholders. In other cases, the insurer may elect to challenge the claim because, according to them, the policyholder isn’t sick enough to need care. In other cases, the insurer may challenge the choice of facility.

Whatever the reasons, we expect to see more denials as insurers attempt to keep profits from Long Term Care Insurance premiums while they ration care. If you have been denied long-term care benefits for Alzheimer’s care or for any other reason, call us at (877) 783-8686. We can help.

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