The battle of acceptance for long-term care

My Judgment Day is April

12, 2021. That will be when all my appeals for CalPERS long-term care (LTC) will be brought before a judge. A year ago I checked into Windchime Assisted Living. I had recovered from a life-threatening staph infection which had lasted nearly three months and affected my type 1 diabetes of 63 years.

I should have qualified for maximum care based on premiums of $150,000 paid for 25 years, Unfortunately, there were planned “exclusions.”

CalPERS insurance carrier has three categorical exclusion principles. The first includes daily deficiencies in 2 of 6 including: bathing, dressing, toileting, transferring, continence, and/or eating. I fail to need assistance in any two of the six. These are short term care requirements not long term.

Secondly, cognitive impairment stands alone in being accepted for L.T.C. I passed the disqualifying test.

Thirdly, which should qualify me; I have a Complex Yet Stable Medical Condition for which I incur covered expense (type 1 diabetes).

My failure for need of 2 of the 6 daily deficiencies has canceled my diabetic need for care. This is discriminatory, wrong, and a means to avoid providing benefits.

I invested seven months in care at Windchime plus a $2,000 Community Fund deposit waiting for a response from LTC. This totals $23,000.

Unable to continue selffunding my stay at Windchime while waiting for longterm care acceptance; my wife Ruthie and I were forced to move into her mobile home in April 2020.

If you have experienced similar care rejections and expenses, please contact me at ubangarang@yahoo.com.

— Dick Cory, Chico