LTC insurance can be very valuable, as it can pay for your loved one’s medical care. However, filing a claim and qualifying for LTC benefits can be overwhelming, frustrating, and time-consuming. Below are five steps you can take to prepare for a LTC insurance claim.
Long-term care insurance claims attorney Jonathan M. Feigenbaum, Esquire can help you navigate the process. Contact Jonathan M. Feigenbaum Esquire today for a free consultation.
What Is Long-Term Care Insurance?
LTC insurance provides benefits for people with physical disabilities or limitations and/or long-term health issues. Benefits cover services such as nursing homes or assisted living facilities, adult day care, and home or community based case. LTC usually involves non-skilled assistance in performing daily activities, including dressing, bathing, going to the bathroom, and eating.
How to Prepare to File a Long-Term Care Insurance Claim
Having LTC insurance is great, but getting your claim accepted and LTC expenses paid is another matter. To help you prepare for filing a LTC insurance claim, here are five things to do beforehand.
1: Designate Someone in Your Family to Take the Lead
Someone in your family must take the lead in filing a LTC insurance claim and working with the attorney to secure benefits for you. It doesn’t matter who it is, so long as this family member is:
- attentive to detail,
- not overly emotional, and
- available for regular phones calls with doctors and the insurance company.
He or she must keep a log to document who they spoke to, and the day and time of the conversation or correspondence, doctors visited, any care received, and medications prescribed and/or taken.
2: Read Your Policy
You and the designated coordinator must be familiar with your LTC insurance policy before you start any claims process. You can receive a copy of the policy by requesting it from the insurance company.
3: Know the Policy’s Benefits
It pays to understand how your policy defines what benefits are available and where and for how long the benefits will be paid. While you’re reading your policy, look for answers to five key questions about the policy’s benefits:
- What is the benefit for assisted living, home care, nursing home, and other care settings?
- How long are benefits available?
- How much is the total benefit pool?
- Are there separate benefit pool amounts for different care settings?
- How long do you have before you reach the elimination period?
4: Understand How Benefits Can Be Triggered
Payments from LTC policies are usually triggered when a policy holder needs help with two out of the six “acts of daily living.” These include:
- transferring, and
- going to the bathroom.
Other policies could require more or less acts of daily living or “hands on” and “stand by assistance” for policy holder to see any benefits. LTC insurance benefits are also triggered by “cognitive impairment.” Cognitive impairment occurs when a person has trouble with his or her:
- ability to learn new things or make decisions, or
5: Follow Up
Once you’ve designated someone to take lead in filing your LTC insurance claim, read your policy, and understand the policy’s benefits and how the benefits are triggered, it’s now time to determine whether you should file a claim. It’s in the best interest of you and the designated coordinator to hire an experienced attorney to verify that you meet the triggers and help you complete the paperwork.
Speak to a Long-Term Care Insurance Claims Attorney
Filing a claim correctly with the right documentation and having it approved the first time can be both difficult and confusing. Long-term care insurance claims attorney Jonathan M. Feigenbaum, Esquire can help you through the process. Contact us today.