Steps to Take Before Filing a Long-Term Care Claim

Baby boomers – those individuals born between the years 1946 and 1964 – are reaching the age in which long-term medical care may become necessary.  Most long-term-care insurance fills in the gap that the insured’s primary care insurance doesn’t cover.  To ensure that a long-term care insurance claim is not denied, make sure you understand what your policy covers.

Most long-term insurance claims are paid.  According to the American Association for Long- Term Care Insurance, in 2012, insurance companies paid over $6.6 billion in benefits to a record 264,000 individuals.  However, many seniors and their families spend months and even years trying to persuade insurers to pay the bills.  To avoid denials, it’s very important to understand what your policy covers and also know what may hamper or prevent a claim from being paid.

Elimination periods: it is very important to know how your policy counts “your elimination period”, the time your insurer begins to pay a claim.

Some policies use calendar days, paying for services 60 days after you file a claim or after your health care professional certifies that you have a covered disability.  However, other plans use “service days,” counting only the days you pay for a home health aide.  If you use a caregiver three days a week, this type of  insurer will only count these days toward the sixty-day waiting period, which means  benefits won’t begin for twenty weeks. 

It is essential to file a claim immediately at the first sign of a problem no matter what the elimination period of your particular policy may be, as the company will need to review healthcare records before approving a claim, a process that takes time.  The sooner you submit the claim, the sooner your claim will be paid.

It is also imperative that your licensed health care provider confirm in writing that you are disabled, whether it be cognitively or physically.  Advocates also recommend that your health care provider basically write a prescription for home health care seven days a week or for nursing home admittance.   This report needs to be specific in the type of care needed and should also reflect the type of care required in the policy.

Before hiring a caregiver, check your policy’s requirement for what type of health care profession is covered.  If you hire an aide that is not covered by your policy, you will be forced to pay for the care he or she provided.  Even if you live in a state that doesn’t require a license for home health aides such as Arizona, if your policy calls for a licensed aide, then only hire only a licensed aide.

Another important step in guaranteeing your claims will be paid is to keep a log of all communications with your insurer, whether it be phone calls, faxes or emails. When you have proof that you forwarded all required paperwork, an insurer cannot use that as an excuse to deny a claim.

Should your insurer delay payment or refuse to pay a legitimate claim, consider hiring an Arizona insurance bad faith attorney to protect your rights and obtain the benefits you deserve.