I first heard of FSC through the Assisted living facility where my 92-year-old mother lives. My mother had been paying monthly premiums ($150 to currently ~$250) on a long-term care policy for about 17 years. When she made the transition from independent living to an assisted living facility, I took a look at the policy and decided to make a claim.
The policy was written in typical “legalese” and somewhat hard to understand and generally ambiguous with regard to exactly what kind of facility is covered. The policy says that ‘we will pay a benefit for each day of confinement… while you are confined in a Nursing Home…’ A nursing home is defined as being licensed by the appropriate licensing agency to engage primarily in providing skilled nursing care…’ The ‘license’ nor the ‘agency’ is defined. In addition, there is a note in this Nursing Home definition section that says that ‘These requirements… are generally NOT met by… assisted living facilities.’ The word ‘generally’ led me to believe that there could be a case where an assisted living facility would be covered. Also, one provision in the benefits section says that a Nursing Home stay is appropriate because: there is a need for ‘Human assistance in performing 2 or more Activities of Daily Living.’ My mother meets these criteria.
Needless to say, this is all very confusing, and hard to understand if one is not familiar with the policy or the law associated with this kind of insurance policy. If you know anything about insurance companies you will know that they make buying a policy very easy and make paying the premium for the policy even easier, but when it comes to making a claim on the policy, there are endless volumes of paperwork and literally hours of waiting on hold on the phone. In my opinion, they make it as difficult as legally possible to make a successful claim. FSC fought this fight for me, which allowed me to continue working at my job, without having to take time off to deal with this time-consuming undertaking. Without FSC I would have had to either take vacation days or use work time to deal with the extensive red tape and legal entanglements presented by the insurance company. In addition, during this transition period, my Mother was in and out of the hospital 3 times. Dealing with her move, medical issues and an insurance claim would have been way too much for me to handle. Thanks to FSC, I could concentrate on making my mother comfortable during this stressful time.
Having been involved as a Hospice volunteer at our local hospital, I have visited most of the Nursing homes, Assisted living facilities, and dementia care facilities in my town. I know from first-hand experience what kind of care one receives in a Nursing Home versus an Assisted Living Facility. The biggest irony that I see is that the level of care and quality of life seen in an Assisted Living facility far exceeds that which is apparent in a Nursing Home. Yet these long-term care insurance companies do not seem to want to acknowledge this fact or cover the facility that obviously provides the better care.