Should We File Hospital Stays on our Long Term Care Claim?

The short answer is “yes”.

Though the hospital stay may not count towards your elimination days on your contract, you won’t know for certain unless you file the documentation on it.

“Long term care” is a fuzzily defined word. Often it is stated that a person is in long term care when their short term care ends. “Short term” means care from which a person is likely to improve. So often this tends to mean Doctor visits, Hospital stays, and rehab care – the types of care that health insurance and Medicare pays for.

While this is all correct, some contracts for long term care insurance will peg the start date on your claim to the event that caused you to be in the hospital (say a stroke, or you fell and broke a hip). If you have a contract that starts the claim date from the event that put you in the hospital, then you can use the hospital days to count towards the elimination window in your contract (also called a ‘wait window’ – essentially the first number of days the policy holder must pay the full cost of care before the policy will start to pay its share. See other blogs for more explanation of the Elimination Window). So when we are filing a claim here at Mrs LTC, Inc., we always submit the documentation for the hospital. If the carrier will count those days then you are that much closer to the claim paying benefit and owe that much less out of your pocket for those first several days.

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