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Over the years we have provided services of one type or another to hundreds of clients who needed to receive care in their home (“home care”) or in a residential care facility or skilled nursing facility (“long term care facilities”). Some of those clients had long term care (“LTC”) insurance coverage.
In almost all cases, when clients or their families have attempted to file applications for benefits (“claims”) under those policies without help from us, they find that the LTC insurance companies (“LTC carriers”) manage to deny or significantly delay payment of benefits under the LTC coverage.
The five most important things to know about filing long term care insurance claims for you or your loved ones:
- Get the initial claim filed right away
- Do not ask the agent who sold the policy to help file the claim; instead, ask for help from someone who does this all the time and is an expert at it.
- Make sure the claim is complete, including all forms and required supporting documents.
- Plan ahead financially – providers will not wait to be paid while the initial claim is being processed so you’ll have to pay out of pocket at least until the LTC carrier approves the insured person’s eligibility AND the provider’s qualifications to provide the services.
- After you have submitted your claim, call the insurance company at least once each week to ask about the LTC carrier’s progress in processing the claim and what your claim’s “status” is.
If you do these five things carefully and complete the claim forms in a thoughtful and thorough manner, you will be well on your way to a more successful, less lengthly claims approval process.