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Filing a Long-Term Care Insurance Claim

Do you have a long-term care insurance policy that you’ve been paying premiums on for years in hopes that you’d never need to use it? If so, the statistics say your hopes are misguided, as it is estimated that 80% our population will need some type of long term care before they die.  Whether it is for care in a nursing home, assisted living community, or in your own home with a caregiver – the chances are you are going to need to activate that policy. Below are some easy steps to turn on your policy and ensure that you get the coverage you’ve paid for all these years.

Step 1 – Understand what your policy covers/pays for and don’t assume that the insurance company is your best resource to do this.

It is common to have a policy for 10 or more years before you need to use it. By that time, many policyholders have most likely forgotten everything their policy covers.  Familiarize yourself with your policy before starting the claim process.  If you don’t have a copy of the policy – call and order a copy.  This may take a week or so, but will be worth it.

You may want to have a third party help you understand your policy better.

The insurance agent or financial planner who sold you the policy can be a good first step.  If they are not around any more you can try an elder care attorney (although they may charge you and hourly rate that can be a little expensive) or even a senior care provider, (they may charge a smaller fee or do it for free if you use them as your provider).  It is also a good idea to involve family members as they may be able to assist in understanding the policy and give you good advice and support as you go through the claims process.

Step 2- Ask the right questions before you start the claim.

It’s okay to call your insurance company and just get policy information before you formally file a claim.  Filing a claim without knowing what is in your policy and how it works is like playing darts in a dark crowded room.  Once you know what is in your policy and how all the moving pieces work together you have a much better chance of getting the claim approved and getting reimbursed for your care needs.

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Step 3- Choose a care provider that is familiar with Long Term Care insurance and knows how to bill the policy so you get paid quickly and fully.

Many Nursing homes, rehabilitation centers, assisted living facilities, and home health companies that provide caregivers or senior care providers don’t know how to bill long-term care insurance companies.  Most of these providers have their billing offices who specialize in billing Medicare, Medicaid, or even private duty (private pay) services.  If a provider doesn’t have experience and is not willing to provide needed documentation you may have difficulty getting reimbursed.

Step 4- Continue to monitor and track what your policy limits are or find a provider who will assist in tracking limits for you.

Once your policy is approved and you are getting reimbursed it is important to do annual updates with your insurance company or provider to determine how much of your benefit was utilized and how much of your benefit remains.  Many policies have a finite amount of benefit (others have unlimited) so make sure you keep track of what is going on and that you strategize with family members regularly to assure you are utilizing and maximizing benefits.


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