Private medical insurance - confusion

Discussion in 'I care for a person with dementia' started by rachococo, Mar 28, 2017.

  1. rachococo

    rachococo Registered User

    Nov 10, 2015
    Hello, I was wondering if I could get some guidance/advice. My father has Alzheimers which was early onset (mid 60s) he is deteriorating and my mum is struggling with the increasing demands at home. Myself and my sisters do not live close by so she doesn't have daily support. My dad attends a day club a few times a week but it has reached the point where my mum is looking for respite and eventually permanent care for him. He has private medical insurance through his previous employer who have activated the serious illness element of the insurance. We have supplied letters from the doctor advising respite and subsequent care. However we are finding it difficult to find out what we will be entitled to help with the costs. We found a care home however they are saying it only covers medical costs and the home would need to have doctors and nurses on site. My dad is still fairly active but needs self care help. We are unsure where to go and how to liase with the insurance company - it seems so confusing. Many thanks,
  2. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    You'd have to look at the actual policy documents to see what it covers but I have to say, I'd be really quite surprised if private medical insurance covered a care home. I get that Alzheimer's is a medical condition, but unless there is a long-term care rider as part of the policy, I'm willing to bet you'll be out of luck.
  3. Beate

    Beate Registered User

    May 21, 2014
    Dementia care falls under social care, and only co-diseases like diabetes etc would fall under medical. I'm afraid you'll be straight out of luck with this one. No medical insurance is going to pay for a care home - it's the person with dementia's responsibility if they are self-funding, and the council's if they are not.
  4. Sammyjo1

    Sammyjo1 Registered User

    Jul 8, 2014
    I have private medical insurance and OH was on my policy. When I tried to get cover for a medical appointment for him I was told they didn't cover mental health and they deemed dementia to be a mental health issue and therefore he wasn't covered.

    I hope your policy is more supportive
  5. Oh Knickers

    Oh Knickers Registered User

    Nov 19, 2016
    Hi Rachoco,

    Anything Dementia related is NHS and Social Services. The one thing I would flag regarding private medical insurance is how much NHS doctors dislike it. I have a challenging sibling who thought going private would speed the process up and that Mother would receive preferential treatment. I did raise a flag regarding this and was steam rollered.

    What happened was Mother's lovely GP got cross. The private consultation could give no proper diagnosis as no test other than a slim dementia test was done. Mother ended up flirting with the private consultant. :mad: The letter was not worth the paper it was written on.

    Mother was then out of the NHS system for 9 months until I begged her GP, very nicely, to reinstate mother into the NHS system. She was then seen by the local Geriatrician who arranged an MRI. On the basis of that, a diagnosis of FTD was made.

    Unless your father is in a position to fully self-fund you do need to tango with SS (Social Services). As part of that process, you need to apply for Attendance Allowance (AA). That is the start of the paper trail for the SS and care homes. Once you have a formal diagnosis you can then apply for a Council Tax Disregard. This can be applied for online on the Council website. It is charmingly called Mental Incapacity Disregard. Another piece of paperwork in the trail.

    SS will assess your parent as to what level of care they need. What I have done is assess about 40 of the care homes in her area. After a lot of research, I have identified 3 that might do that are in her price bracket and will be likely to be eligible for SS top-up funding without having to move her. Once I have visited them a judgement can be made. Mother will, after a while, need SS top up so SS does need to be involved. A very good overview of the process has been related by Ann Mac in her thread So Bizare.

    I did look at 3 other homes. One seemed really nice and we reserved a place. However, on another visit, a year later, to take a sister to come and look the care was appearing a bit frayed as was the home. It failed on CQC (Care Quality Commission) inspection. A new manager was appointed and fees have shot up to £76K for dementia care. Another local care home has a good CQC report but when I visited it was a shocker and stank of urine. So always visit.

    Your local Alzheimer's Society office will have a very good view of how things work locally. Scroll down the page and put your parent's post code in:
    They can also guide as what dementia clubs there are locally for your Dad.

    I didn't mean to write so much. But hope it is of help. It is such a steep learning curve.

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