Long-term care insurance can provide great peace of mind, but utilizing those benefits can turn out to be a complex undertaking for older adults and their family members. To help steer families through this process, here is an informative overview from the experts at Help at Home Senior Care.
Exactly what services are covered?
Ahead of submitting a claim, it is important to thoroughly read the long-term care insurance policy so that you can gain an understanding of the types of services the policy covers. If you do not have a copy of the policy, contact the provider to request one.
Even though all policies vary in what they cover, long-term care insurance normally covers non-medical services at home, provided assistance is necessary with a minimum of two or more activities of daily living, or the policyholder has been diagnosed with some type of cognitive difficulty, such as Alzheimer’s. Examples of the kind of care that long-term care policies may cover are:
- Personal care needs, such as bathing, showering and getting dressed
- Ambulation and transfers
- Using the bathroom and incontinence care
- Preparing meals and feeding
- Household chores
- And others
If you or a senior loved one is in need of help understanding the specifics of the policy, an insurance agent, elder care attorney or financial planner may be helpful.
Will all of the costs for care be covered?
While specific plans vary, each plan outlines the allowable monthly coverage, which is identified as the “present daily allowance,” and often includes a lifetime maximum ceiling. Policies also generally identify a particular duration of time for which the benefits are accessible, such as five years, or if the coverage is in effect for the remainder of the policyholder’s lifetime.
It’s also essential to review the long-term care plan’s elimination period. The elimination period is the time during which the cost of care needs to be paid out-of-pocket initially, until a specific amount of time has gone by. Though some plans specify a zero-day elimination, which means cost of care and coverage begin immediately, other policies can require as much as 120 days of care first.
Pick your care provider very carefully.
If you plan on filing a claim for long-term care insurance, it’s vital to work with a home care company with experience in billing long-term care insurance providers; otherwise, there is the potential that the claim might not be completely reimbursed. Help at Home Senior Care has experience with helping families access their long-term care insurance benefits and can provide the documentation required to help clients file claims correctly.
How can claims be filed?
In order to file a long-term care insurance claim, the following documents are normally necessary:
- A claimant’s statement (or policyholder statement) outlining the reasons for the claim
- A physician statement completed by the doctor, confirming that care is warranted
- A prescribed care plan and nursing evaluation
- A provider statement, completed by the home care agency
- An authorization form
After the claim has been completed and submitted, a phone interview is scheduled with the insurance company’s claims department, and after that the claim is either accepted or declined.
If you are seeking to receive home care services through a long-term care policy, reach out to Help at Home Senior Care. You can feel confident in knowing that we have years of experience in not just supplying expert care in the comfort of home, but also in aiding families with long-term care insurance claims and receiving the most out of their plan. To learn more about our respite care in Lincoln, CA and other nearby areas, call our team at (530) 885-7444.