Filing Long Term Care Claims In San Diego County – How To Do It – Part Four

Introduction

In Parts One, Two and Three, the previous articles in this series, we described how to start the filing of the Long Term Care Insurance (“LTCI”) claim and how LTCI companies sometimes delay, and sometimes even avoid, paying LTCI claims, and how important it is to have a copy of the LTCI policy.  In Part Four, the last installment in the series, we will describe how important it is to get your In-Home Care Agency assist you with completing the Provider Information section in your claims package forms, and we’ll talk just a bit about LTCI companies’ ethics.

Ask Your In-Home Care Agency To Complete the Provider Information Form in the LTCI claim forms package

While you may only file one or two LTCI claims during your lifetime, your In-Home Care Agency has probably worked with many families who have LTCI claims and ongoing reimbursements.  Because of that, experienced home care agencies often have a fair amount of experience and expertise with respect to getting LTCI claims filed and perfected.

Each In-Home Care Agency makes its own policies and procedures for assisting with LTCI claims.  Some home care agencies may charge a fee for filling out that form or helping with some or all of the other forms necessary for their clients’ LTCI claims.  You’ll need to ask your home care agency for their policies and fees in this regard. We’ll talk more about that in a future article in this series.

At a minimum, though, your In-Home Care Agency should be willing to complete the form that the insurance company will require that makes it possible for the insurance company to approve the In-Home Care Agency as a “provider” under the terms of the insurance policy.  The insurance company will only pay benefits under the policy in the insured person is receiving services from a “provider” that the insurance company has approved.

InCalifornia, at the time that this article is being written, there are no state regulations and no licensing available for In-Home Care Agencies operating inCalifornia.  Sometimes LTCI companies will try to deny approval for such companies, since they don’t have a state license.  This is one good reason to work with a In-Home Care Agency that has a lot of experience because that way the In-Home Care Agency will know how to address, and overcome, those objections from LTCI companies.

In summary: your In-Home Care Agency is best choice for completing the Provider Information form, so ask them to help!

A Final Note:  Insurance Companies’ Ethics

Throughout this series of articles, we have been saying things that make it seem like we believe that long-term care insurance companies would prefer to not pay claims.

In fact, we do believe that.

However, we also believe that insurance companies are not proactively trying to cheat policyholders, at least not in most cases.   Insurance companies, like any other businesses, exist to make a profit (even the ones that claim to be non-profits or member-owned) and so when they don’t have to pay claims, they are able to increase their profits.

Nonetheless, is there an ethical question about the way that insurance companies conduct their claims administration process ?  Does it seem sometimes like insurance companies have designed their processes to delay or avoid paying claims to policyholders?

We’ll leave it up to you to decide what you believe about that.  We don’t conduct our business the way the insurance companies do, but the insurance companies don’t ask us how to run their businesses.

Summary

So, always be sure to ask your In-Home Care Agency to assist with the preparation of your claim, at least the Provider Information section of the forms.  A Servant’s Heart Care Solutions is already to assist in all possible ways when families need our help in preparing LTCI claims, and so should your In-Home Care Agency.

 

Call (760) 744-8200 Today For Assistance With
Filing Your LTCI Claim and Your In-Home Care Needs!

A Servant’s Heart Care Solutions has assisted many clients and their families file their LTCI insurance claims since 2003.  It would be a privilege for us to have the opportunity to help your family as well!