Thank you again for all the suggestions! I will be reading the link later about the FCC and internet. The first post sounds is very similar to what we have been going through since moving to this property in 2014.
I have been on calls for most of the day so far. I found a phone number for a Plan Administrator near the back of MIL's policy. The woman who answered said I needed to call a different number for the Benefits & Resources. Understandable the number changed with it being such an old policy. After reaching Benefits & Resources, there was no LTC option in the phone tree. The "other reason" representative was extremely helpful, but she was having a lot of difficulty finding anything on LTC. She found a number to call John Hancock and when she called it, a casino that answered. She finally found some info stating their company no longer managed LTC plans. Reaching out to her supervisor, they put me in touch with someone who is going to try to find a US based contact with John Hancock and will get back to me later whether she has an answer or not.
I gritted my teeth and called John Hancock again. All their calls typically involve at least a 20 minute wait time before anyone answers. I asked to be transferred to someone in the United States. When I reached someone in the US, she too was from a call center. I asked for documentation that defines "substantial supervision for a severe cognitive impairment" and she said there is no documentation. That she could mail me a copy of the policy. I told her I have the policy in my hands and there is no definition of what "substantial" and "severe" is. She did say this policy is set up to trigger with either the need for 2 of the ADL OR "severe cognitive impairment." It does not need to be both. I asked her what needs to be provided in order to claim her cognitive impairment. Her answer was "A letter from her doctor stating she has dementia." I already faxed that letter to them on 3/10/22. This girl was not making policy decisions. Her job is to answer calls for probably dirt cheap. She tried to be helpful and really encouraged me to fill out the appeal documentation.
The next step is I am waiting for the doctor (DNP) and her boss (MD) to write their letters indicating MIL has dementia and needs supervision. They will have the letters notarized. Then I will fax the letters and the appeal letter to John Hancock. Instead of an appeal letter, I'm creating an itemized list including dates. Things like She responds with "Yes Mommy" and "Yes Daddy"; She can't manage her daily meds; She cannot remember what food she ate for lunch 15 minutes ago; She does not remember how to lock/unlock the brakes on her 4-wheel walker, etc. I'm up to 47 items so far. Both my LOML and I will sign the appeal and have it notarized for good measure.
Since I am self-employed, I'm the one with more flexibility in my schedule to make calls, meet with Senior Facility staff, as well as run MIL around to her various appointments. Dealing with all her finances and medical insurance and life matters has been fairly easy. Dealing with Long Term Care is turning into a full time job for me.
I agree 100% about documenting everything including what number was dialed. I kept casual call notes when I started managing all her care, but once I started dealing with John Hancock, that all changed.
I will update this when I have more information and/or progress. It's going to be useful for someone else at some point.
I read recipes the same way I read science fiction. I get to the end and I think, "Well, that’s not going to happen."