Is Making a Claim for Long-Term Care Insurance Benefits Difficult?

It is one thing to own a Long-Term Care Insurance policy - it is another thing to use the benefits when you need long-term health care. Is the claim process complicated?

In 2021 the top insurance companies paid over $12.3 Billion in Long-Term Care Insurance benefits to policyholders - much of it paying for in-home care services. Long-Term Care Insurance does work! 

Benefit Triggers

The policy language is straightforward if you own a tax-qualified Long-Term Care Insurance policy. Most insurance companies have an outstanding track record for prompt, responsible claims payments. 

To be eligible for the payment of benefits under all provisions of a Long-Term Care Insurance policy, you must meet the following requirements:

• You must be chronically ill; meaning you are unable to perform at least two activities of daily living without substantial assistance from another person who is physically present with you for a period that is expected to last at least 90 consecutive days due to a loss of functional capacity -

OR

• You require substantial supervision to protect yourself from threats to health and safety due to a severe cognitive impairment.

Most insurance companies will require a written plan of care from a licensed health care practitioner prescribing the services you will need.

Paperwork

Most insurance companies will need paperwork completed. In some situations, an assessment may be required. ‍Most LTC Insurance policies have an Elimination Period, a deductible based on DAYS, not DOLLARS. Some companies offered zero-day elimination periods; however, 90 or 100 days (once in a lifetime) are common.

Remember, health insurance, including Medicare (and supplements), will only pay up to 100 days of skilled services. The days paid by health insurance or Medicare WILL COUNT against your deductible. 

The process of getting benefits from your Long-Term Care Insurance policy begins with submitting claim forms to the insurance company.

There is usually never a good reason to delay submitting a claim.

Get Free - No Obligation Assistance with LTC Insurance Claims

LTC NEWS has arranged for free, no-obligation help and assistance with completing the claims process to assist you no matter what insurance company you - or your loved one - has in place - no matter who sold you the policy in the first place. 

LTC NEWS can even help if you or your loved one does not own Long-Term Care Insurance but needs help finding quality care and developing an appropriate plan of care.

You can also find the contact information from major insurance companies with Long-Term Care Insurance policies in place.

Learn more - Filing a Long-Term Care Insurance Claim | LTC News.

Most insurance agents and financial advisors who sell Long-Term Care Insurance have little or no experience processing claims. Many Long-Term Care Insurance specialists do have this experience and can be helpful. 

The Steps

If you don't want to get help with the process, you should know these steps when processing a Long-Term Care Insurance policy claim.

The first step to filing a long-term care insurance claim is to contact the insurer to obtain all necessary claim forms. These forms can be mailed - sometimes emailed - and should be completed fully. 

Be sure to have the policyholder's complete information (full name, social security number, and policy number). You can find the contact information for most insurance companies that have sold Long-Term Care Insurance by clicking here.

If you are helping the policyholder, you may need to have a medical power of attorney or have a signed HIPAA form allowing the insurance company to communicate with you during the process.

Keep detailed records as you may have to speak with the claim's department employees a few times during the process. Note when you called and to whom you spoke and what was discussed. 

Never mail an "only copy" of any form or document. Keep a copy for your records. 

Most providers will bill the insurance company directly; however, some will not. Discuss with the provider. Many providers today understand Long-Term Care Insurance and are very happy to help you through the process. 

Once the claim is approved, there are usually few problems going forward. It can take anywhere from 3 to 5 weeks to process a claim - much of that time waiting for medical records. Be proactive and ask the doctor to process the requested information right away.

Seeking help, whether through LTC NEWS or elsewhere, will make this process much easier. 

The best Long-Term Care Insurance policy is the one that is paying benefits when you need care in the future. The process can be easier if you understand the steps and seek professional help. LTC NEWS can even provide you with free, no-obligation assistance with this process. 

If you have a policy, don't delay in making a claim for benefits - that is why the policy was purchased in the first place. Plus, many companies offer professional case management, which is available right away.