Getting Long-Term Care Benefits Paid

Get Authorization To Act In Policy Disputes
If a friend or loved one needs Long-Term care, get a signed statement authorizing you to act on his or her behalf in policy disputes. It need not be a power of attorney — just a statement that’s signed. Remember to do this early if a parent is suffering from dementia.

Read The Policy
If you don’t have the policy or can’t find it, ask the insurer to send one. Never submit a claim without first reading the policy closely.  It’s important to characterize your claim properly and in a way that supports your ability to get benefits paid.

Submit As Much Evidence As Possible
When filing a claim, don’t feel confined to include only the information the claim form asks form. Don’t feel constrained by the boxes on the form. Submit as much as evidence as you must substantiate your claim, such as information from your parent’s physician or caregiver. Include a physician’s ‘certification of necessity of treatment’ or ‘plan of care.’

Put It In Writing
If you’re having trouble getting the insurer to pay a claim, put it in writing and send the letter to the company. Don’t try to resolve a problem over the phone. Create a paper trail to track what was said and by whom. A letter doesn’t leave room for ambiguity the way a phone call does. IIf the insurer makes an unreasonable demand, like saying you need a power of attorney to represent your parent, send a letter saying ‘You instructed us that we need power of attorney. Please provide the authority for that.’

Get Daily Care Notes
If you plan to hire a home health aide from an agency, make sure the aide will keep “daily care notes.” Insurers often demand these before approving home-care claims.

Don’t Let Your Friend or Loved One Face Insurance Company Alone

Be with your friend or loved ones when the insurer sends an employee or agent to conduct an assessment. The policyholder might be too proud to tell the interviewer what he cannot do — such as dressing, feeding or bathing himself — which could lead to claims being denied. If you’re present, you can set the record straight and encourage the policyholder to demonstrate his limitations. A supportive voice will help your friend or loved one get paid.

Set Up Third Party Designee

Inform the insurer you want to be a third party designee and receive a copy of any lapse notices. This way, if there is an issue with premium payments, you’ll know and can remedy the situation.