Filing Long-Term Care Insurance Claims

Long-term care insurance claims are just one of the many things that can overwhelm family caregivers. Policy documents are long, filled with exclusions, and written in difficult language. The claims process is complicated.

How can family caregivers make sense of their loved ones’ long-term care policies? We posed this question to Janice Fitchhorn, the elder care coordinator at Truhlsen Elder Care Law of Nebraska, a Life Care Planning Law Firm in Blair, Nebraska. Janice has guided many families through the long-term care insurance labyrinth.

Understanding what the policy covers is the first hurdle. “Most people don't know what is covered,” Janice explained. “Will it cover in-home care? Will it cover care at a nursing home or assisted-living facility? If you don’t understand the terms of the policy, it’s easy to get tripped up.”

Assuming that the facility is qualified under the long-term are policy is another common problem. “One family admitted their father to a memory care facility before coming to work with us,” Janice said. “Both the placement agency and the memory-care facility knew that the man had long-term care insurance, and the family was told that the long-term care insurance policy would cover that facility. Six months later, they discovered that the memory care unit was a non-qualifying facility, which meant that they had to pay for that six months out of pocket.”

Waiting too long to use the policy is another issue. “Many people think they should wait until they get to the nursing home to file a claim,” Janice said. “They don’t realize that their policy may cover in-home care.” Placing a person in the wrong level of care is another mistake Janice sees. “If their policy doesn't reimburse for assisted living, and their facility is licensed as assisted living, they won’t be reimbursed.”

Keeping up with changes in the long-term care policy is another issue that many families overlook. Long-term care policies issued decades ago were often very generous. Since then, most companies have scaled back on the benefits as care costs have increased. If an older adult didn’t keep up with policy changes over the years, family members may be in for a surprise when they file a claim. “A family member may look at the original policy and think that Mom has one set of benefits,” Janice said. “It’s a shock when you discover the reality is far lower.”

What can you do to avoid these land mines? Working with an elder care coordinator in a Life Care Planning Law Firm is a great place to start. “If the family gets me involved early enough, I can steer them around every problem,” Janice added. “I can get the claim filed correctly from the beginning, which means the family avoids the time-consuming appeals. I know how to read the policy documents, I know how to determine whether a facility qualifies under the policy, and I know what kind of documentation to ask for. And I know how to package everything up in order to file the claim.”

Ultimately, working with the team of professionals at a Life Care Planning Law Firm pays off for everyone. Older adults get the care they need faster, while enjoying more dignity and independence. Family caregivers spend less time trying to manage a process that they may not understand. It’s a win-win for everyone.

Find a Life Care Planning Law Firm near you.