Success Tips For Long-Term Care Claims – Part 4

Success-Tips-For-Long--Term-Care-Claims---Part-Four

by Tim Colling~In Part One of this series, we offered a list, shown below, of tips about how to prepare and file claims for benefits under Long-Term Care Insurance (“LTCI”), promising to provide more detail. In Parts Two and Three, we covered the first four of those six tips. In this final installment, we’ll cover the last two tips and wrap it up.

  1. Choose one person to be in charge of filing the claim.
  2. Be very organized, prompt and businesslike and get the claim filed right away.
  3. Get help in filing the claim from someone who knows what they’re doing.
  4. Make sure the claim is complete when you submit it, including all forms and required supporting documents.
  5. Plan ahead to pay out of pocket until the insurance company approves the claim.
  6. After you have submitted your claim, follow up at least weekly and keep notes.

Plan ahead to pay out of pocket until the insurance company approves the claim.

You should expect the LTCI company to take at least four calendar weeks, and probably more, before it begins paying benefits under the policy. Most caregiving service companies or long term care facilities will require that you pay for services out of pocket until the claim is finally approved.

Also, many LTCI policies contain “waiting periods”, “exclusion periods” or similar provisions which require that services be received and paid for out of pocket before benefit payments begin, and that the waiting period out of pocket payments will not be reimbursed.

For these reasons, you should budget for paying those costs on your own during any waiting period, and while the claim is being processed.

Bonus Tip #1: Waiting Periods

It is VERY important to understand the terms and conditions of any waiting period that the LTCI policy may contain. Understanding them clearly and completely may allow you to optimize the use of our own out-of-pocket funds and minimize the total amount that you have to pay during the waiting period.

Bonus Tip #2: Have A Copy of the Policy and Read It

It is VERY important to have a complete, original copy of the LTCI policy, and to read it and understand it. If you don’t, you can request a copy of the policy from the LTCI company, but you should know that we have seen cases where the LTCI company sent a “copy” that left out key policy provisions, endorsements or other information that was beneficial to the insured, and without which the claim would have been denied.

In those cases, the claims were only approved once the family was able to locate the original policy documents and then prove that the “missing” policy terms had in fact been left out. The LTCI companies claimed, of course, that those errors were unintentional oversights.

After you have submitted your claim, follow up at least weekly and keep notes.

Like any other large organization, LTCI companies tend to be lethargic and to pay attention to the squeaky wheels first. We recommend that you submit the claim to them in the fastest manner possible (fax, email, or overnight express) and that you follow up with them by phone the next day to confirm that it was received. At that point, you should ask for an approximate timetable for their initial processing of the claim. After that, you should call and check on the status of the claim’s processing at least once a week, and maybe even once every three to five days.

Every time you call, take detailed notes including at least these things, if not more:

  1. The number you called.
  2. The date and time of the call.
  3. The name of the person to whom you spoke including their phone extension (if they allow that) or at least some other way to identify that specific person. It won’t help you later on if your notes say that you spoke with “Mary” and they have 32 persons working there named “Mary”.
  4. The details of the conversation: what topics were discussed, what they said, what they promised, and what you promised. When promises are made, ask for deadlines for the fulfillment of those promises.

Summary

  • Make sure that you have an original copy of the policy and if not, request one from the LTCI company but be aware that it is much, much better to find the original.
  • Read the policy and make sure you understand it fully.
  • Make sure that you fully understand any “waiting period” and how to satisfy it at the most optimal out-of-pocket cost.
  • Be prepared to pay out of pocket for caregiving or long term care facility costs for at least four weeks, and probably longer, after the initial claim is filed.
  • Once the claim is filed, call often to ask about the progress made on the claim’s processing and keep detailed notes about those calls.

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About Tim Colling

Tim Colling has more than 30 years of experience in management in a variety of industries and has served in the past as a member of the statewide steering committee for the Home Care Aide Section of the California Association for Health Services At Home (“CAHSAH”). He is a Certified Public Accountant (licensed but not actively in practice), and received his Bachelor’s Degree in Accounting from California State University at San Diego. He has held the credential Care Manager Certified ("CMC") from the National Academy of Certified Care Managers, and has practiced actively as a Professional Geriatric Care Manager. Tim has worked as a CPA in Public Accounting, a corporate Chief Financial Officer for a chemical manufacturing company, and a software engineering manager for several private and public software companies, in addition to working as an eldercare manager, in-home caregiver agency administrator and professional geriatric care manager since 2003. Learn more about his in-home caregiving company at A Servant's Heart In-Home Care

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