Successful Tips For Long-Term Care Claims – Part One

Long-term-care

by Tim Colling~Over the years our company has provided caregiving services for hundreds of clients in their homes so that they wouldn’t have to move to nursing homes.  Some of those clients were fortunate enough to have long term care insurance (“LTCI”) coverage to help pay for those caregiving visits.

In this article series we’ll tell you what you can do to secure a successful, prompt approval of your own LTCI claim in order to cover part or all of the cost of in-home caregiving services.

By helping our clients and their families file more than a hundred LTCI claims, we’ve been in a perfect position to observe and learn some of the most important steps to take in order to avoid claims being denied or delayed. Our recommendations in this article series are based on our experience.

Summarizing The Most Important Tips

Here is a summary of the most important things to do when you file your own LTCI claim. We’ll provide more detail about each of these in each of the future articles in this series.

Choose one person, usually a family member, who is going to be in charge of filing the claim.

Be very organized, prompt and businesslike and get the claim filed right away.

Get help in filing the claim from someone who knows what to do and how to do it.

You could ask the agent who sold the policy to help, but often the agent may not be the best equipped to help you. Insurance agents are usually very well-trained on selling policies, and less well-trained on helping file claims.

The home care company that will be providing the care services is often the best choice. Home care companies are usually very experienced at helping clients and their families file claims.

Make sure the claim is complete when you submit it, including all forms and required supporting documents. Most insurance companies will delay claim approval by initially disclosing only a partial list of the documents that they will eventually require. Therefore you should ask for the entire list when you first notify the insurance company that you want to file a claim.

Plan ahead financially: home care companies will usually not wait to be paid while the initial claim is being processed so you’ll have to pay out of pocket at least until the LTCI carrier approves the insured person’s eligibility and the home care company’s qualifications to provide the services.

After you have submitted your claim, call the insurance company at least once each week to ask about the LTC carrier’s progress in processing the claim and what your claim’s “status” is. When you do so, keep thorough notes, including the date and time of each call, the telephone number that you called, and the name of the person that you spoke to.

If you do these things carefully and complete the claim forms in a thoughtful and thorough manner, you will be well on your way to a more successful, less lengthy claims approval process.

The Insurance Company is Not Motivated To Help You File Your Claim

Insurance companies are only required to honor the terms of the policies that they sell. They are not allowed to cheat you, and they are not required to help you. They are only required to have a process which, if followed correctly and exactly to their requirements, makes it possible for you to file a claim.

Insurance companies earn profit by investing premium dollars for as long as possible, and they stop earning when they have to pay out benefits under the policies. This creates a perverse incentive for insurance companies to find excuses to delay paying benefits for as long as possible. Some insurance companies are worse than others in this regard, but all of them employ a basic set of delaying tactics.

Note: some insurance companies will send out a nurse to make an assessment. Do not be fooled into thinking that the nurse’s job is to help you. Instead, the nurse’s job is to make sure that you are in fact eligible for benefits based on your physical or cognitive condition. The nurse will not dishonestly find you to be ineligible, but the nurse usually also won’t be there to help you in any way.

Summary

Remember, make sure that when you do file the claim, you do everything you can to make certain that the claim information and forms that you send are complete and sufficient for the LTCI company to decide upon the policyholder’s eligibility without further delay. We’ll provide more detail and more tips in future articles in this series.

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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

3 thoughts on “Successful Tips For Long-Term Care Claims – Part One

  1. Rachelle Collins

    People definitely need guidance when filing for long term care insurance nowadays since there are some who are complaining that their insurance company will not pay up. It’s not really because the company doesn’t want to pay up but because their policy doesn’t cover their expenses. I know this is really stressful but with the help of the tips you’ve shared here, I’m pretty sure filing for ltci claim will go swiftly and smoothly. For additional tips, here is an article that can help you avoid conflicts when filing for claim: http://www.ltcoptions.com/5-tips-making-long-term-care-insurance-claim/.

    Reply
    • Tim Colling

      ” It’s not really because the company doesn’t want to pay up but because their policy doesn’t cover their expenses.”

      With respect, I disagree: the companies do not “want” to pay, but they may be contractually obligated TO pay. The issues discussed in this article have arisen when the policies DO cover the expenses, and the insurance companies employ claims filing tactics which have the effect, if not the intent, of delaying and discouraging claims.

      This is not to say that LTC insurance is a bad thing. In fact, my assessment is that most people SHOULD have LTCI. The timing of the purchase decision and the selection of the company and the policy are important, but in general, from my perspective as a professional in the elder care industry, it is a good idea to have LTCI as a way of preserving the estate for the well spouse and the heirs.

      Reply
  2. Pingback: Success Tips For Long-Term Care Claims - Part Two

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