Insurance Claims for Long-Term Care: Your Checklist

insurance-claim-formWhile knowing your loved one has the appropriate long-term care insurance plan in place for when the time comes that such a service is necessary can ease your mind, what will not ease your mind is the process of claim filing. The fact is there are different kinds of long-term care policies, and there are therefore different qualification guidelines for each claim. There is also different federal and state level licensure issues to deal with, and it can prove a complex process for anyone looking to navigate their way through long-term care claim processing. Here are five things you should consider before you put in that claim:

Make Sure You Always Follow Up on the Claim:

If you have reviewed the policy with care, you will have to go through a verification process to make sure the person you are responsible for meets the necessary triggers. You will also need to verify if you have authorization to assist your loved one with this process. It’s best if you write everything down in a journal and document everything – this way you will have necessary information at your disposal. Track the doctors your loved one sees, the care given to them, the medicines the individual is taking, and expect the long-term care paper to arrive within a month’s time.

When filling out the application make sure you leave no stone unturned – every question must be answered to the best of your ability (you don’t want an unanswered question to tie you up from getting the long term care your loved one requires). Make sure you follow your own tracks and check up on everything – don’t expect anything to be done for you or correctly. If you fax a document, call and verify it was received and who received it. Make sure you even follow up on any requests for documents from your loved one’s physicians.

Policy Benefits: Make Sure You Understand Them

It is imperative you have an understanding of what benefits the policy covers. You need to know the terms and what is paid out when. There are some very specific questions you need to pose if you are to have the information you require and if you are to be empowered by the information you gather. Ask the following questions:

  • What are the benefits for nursing home, home care, assisted living and alternative care settings?
  • Can you define the benefit pool amount?
  • Are the pool amounts separate in relation to care settings that differ?
  • Can you define the elimination period?
  • How long does the benefit period last?

What Are Benefit Triggers and How They Affect the Long-Term Care Claim?

Triggers are things that the long-term care patient needs assistance with; such triggers include things like using the toilet, eating, dressing, and bathing. If the elderly requires assistance with two or more of the latter issues or two out of sox acts of daily living, than the individual might be eligible for long-term care, but that depends on the triggers referred to in the policy. If there are terms like stand by assistance and hands on used in the insurance policy, make sure you have these terms defined for the purposes of your clarity. Knowing the meaning of such terms is crucial since such terms play a critical role in whether or not long-term care benefits are received.

Review the Policy Carefully

Make sure you review the entire policy, especially before you call the insurance company to begin a claim filing process. If you don’t have a copy of the policy, then get in touch with the company and have one sent to you. While you are at it, verify the present address on the policy: A duplicate copy will only be mailed to the address the company already has on file.

Choose a Family Coordinator

It is important that you choose a non-overly emotional individual who is organized, for the task of family coordinator: A person who pays attention to the smallest of details. The person you choose will need to have enough time to deal with insurance company representatives and doctors on the phone. The same individual will have to be responsible for tracking all documentation, notes on who they spoke with along the date and time the conversation took place, and record all correspondences.

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