Long Term Care Insurance Claims – Not What You Think

Long Term Care Insurance claims like taxes

Hire a Professional

Typically when our parents get to where they need some help managing finances and medical issues, one child will show up to be the primary help-giver (usually the one who lives closest!).  And since the early stage of help often involve taking Mom or Dad to the doctor (that should be plural!  Primary care, Cardiologist, Oncologist, Rheumatologist – you will eventually find that one of these “ists” is the one that will be the death of you.  Literally!).  When you do show up at the doctor’s office, you take your parent’s Medicare card out and hand it to the nice lady at the window.  She photocopies it and that is the last you see of any insurance issues.  So most people think this is how insurance works – we give our policy info to the care giver and the care giver will make it all come out right.

The reason this works in health insurance is because patients sign a document called “Assignment of Benefits” which assigns all the benefits from your insurance to the care provider.  So, now the care provider is motivated to hire a small army of people to work in the backroom filing long term care insurance claims, sending in medical records and fighting appeals.  You and I, as end users, never see all this diligent, detailed activity that is done on our behalf.

Long Term Care Claims don’t work like that….

If you hand your long term care insurance policy to the care provider (Home Health Care company or assisted living or nursing home), they may verbally tell you that they will file this and help you with it.  But in truth all that person an do is their limited part of the LTC claim.  Long Term Care insurance carriers will also require proof of medical need for the care from the doctor, and often medical records from any hospital stay and/or rehab stay that you have had prior to needing this type of care.  The very nice staff member who has blithely told you that s/he will file the long term care claim for you has no idea that all these other documents are required and, worse yet, they have no legal authority to pull those on your behalf or financial motivation to follow up on all these dangling documents.

Finally – to bring the whole gloomy thing to a final point of “oh my gosh!” – every one of these documents that is required to have proof of claim eligibility is compared to the contract triggers written in the policy and to each other.  They have to match for there to be a “yes” on your long term care insurance claim.  If things do not match the contract or do not match each other, this can be cause for your claim to be denied.

Please don’t hear me dogging the insurance carrier over all of this.  This is also normal in health insurance.  It is just in health insurance (like Medicare) there are more standardized techniques and codes that render the process more transparent – and remember that the doctor has hired a trained army of professional to chase it all down!  In long term care there is little standardization, no codes, and you have become the “army” to chase everything down in order to get your LTCi claim approved.

We encourage folks to get long term care insurance claim filing help from a professional.  It is like taxes – you CAN do this on your own and it may or may not end up in your favor.  If you hire a professional you are more likely to get it done right and have it come out the way you need and deserve.

If we can be of assistance here at Mrs. LTC – give us a call or contact us thru the website.  We have teams of people here who specialize in these types of long term care insurance claims.


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