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5 Things to Do Before Filing a Long-Term Care Insurance Claim

A Place for Mom Staff
By A Place for Mom StaffFebruary 9, 2016

Discovering that your loved one has Long-Term Care Insurance (LTCI) in a time when you’re wondering how to afford the care they need can be a great deal of help. Filing that claim for that policy to pay correctly for care may be another story.

That’s because of how many policy types there are, how qualifications for care work for each one individually, and the different licensure of care settings at the state or federal level. Navigating this process can be complex and you may need help.

5 Things to Do Before Filing a Long-Term Care Insurance Claim

Let’s look at five things to do to start a claim correctly.

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1. Designate a Family Coordinator

This is extremely helpful when thinking about filing a LTCI claim. This person should be well organized and have great attention to detail. They will need to have availability for phones calls to physicians and the insurance company that occur often. The coordinator for the family will need to keep documented notes with who they spoke to, day and time. All correspondence should be tracked and have a record. It’s important that this person can focus on the process and not be overly emotional.

2. Read the Entire Policy

Read the policy before you start any process and before you call the insurance company. If there is no copy of the policy available, call the insurance company and request a copy to be sent. Make sure the insurance company has the correct address on file. Often times the insurance company will only mail the duplicate copy to the address on file.

3. Understand the Benefit Triggers

Long-Term Care policy payments are typically triggered once the insured needs help with two out of the six acts of daily living (ADL’s). Different policies may call for more or less in order to trigger benefits.

ADL’s include:

  • Bathing
  • Dressing
  • Eating
  • Transferring
  • Toileting
  • Continence

Although ADL’s are a standard list, policy language is often different so make sure you understand what “hands on” and “stand by assistance” mean. This can effect eligibility for payment for the individual policy.

The second way to trigger a policy is cognitive impairment. The Center for Disease Control defines cognitive impairment as: “When a person has trouble remembering, learning new things, concentrating or making decisions that affect their daily life.”

Again not all policy language is the same so it’s crucial that before making a care giving decision or submitting a claim to read the insurance contract that your loved one owns.

4. Understand the Policy Benefits

Different policies will have different terms defined for what and where the benefits will be paid. Understanding what questions to look for is most important.Here is a partial list to get you thinking while you’re reading the policy.

  • What is the benefit for different care settings? (Assisted Living, Home Care, Nursing Home)
  • What is the benefit period?
  • What is the total benefit pool?
  • Are there separate benefit pool amounts for different care settings?
  • How long is the elimination period?

5. Follow Up

After reviewing the policy, verify to the best of your ability that your loved one meets triggers. Make sure you are authorized to help them in the process. Remember to start a log. Keep track of doctors, any care received, medications that might affect your claim.Within 30 days the claim paper work should arrive. Fill out every line. Using not applicable is important. If you fax something call and make sure the insurance company received it. Follow up on all records request to doctors or facilities to provide the insurance company with that information.

Submitting a claim correctly and having it approved the first time with the right documentation can be difficult and time consuming. Chances are, if you are reading this and trying to figure it out, you already know that. There is help however. ClaimJockey offers a service to help you file your claim properly.

“After my 91-year-old, widowed father had a stroke, he was suddenly catapulted to completely care for himself again. As his daughter and power of attorney, I found myself navigating unfamiliar territory. I became overwhelmed and intimidated… I learned about ClaimJockey and gave them a call. It was the best decision I could have made.” -Wanda Martin

What questions do you have about filing a long-term care insurance claim? Share them with us in the comments below.

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