Getting the Most From Your Long-Term Care Insurance

In many cases, getting a long-term-care claim approved is the easy part. It's the ongoing paperwork that drives families crazy, especially if you have to submit home-care reports with details of daily care. Here are some tips:

• Ask for Assistance - Some long-term-care agents will help with claims paperwork, so ask about that when you're buying a policy. Several insurers now provide a "care coordinator" for long-term-care claims. The coordinator -- often a nurse or a social worker -- can answer questions about claims, initiate the paperwork and guide you through the claims process. It helps to call when you first suspect that your relative will need care, even if it's long before he or she will become eligible for benefits. The care coordinator can explain what needs to happen to qualify for benefits and which types of facilities and caregivers you can use.

• Hire Appropriate Help- Finding an eligible caregiver at the outset is a key way to avoid long-term-care payment problems. In many cases, a family hires a caregiver before contacting the insurer, only to discover later that the caregiver doesn't meet the policy's criteria for reimbursement. Some policies require a caregiver to work for an agency; others require licensing. A few insurers reimburse family members to provide care, but most policies specifically prohibit it.

• Understand the triggers- To qualify for long-term-care benefits, a policyholder usually needs to demonstrate that he or she requires help with at least two activities of daily living (such as bathing, dressing, eating, continence, transferring and toileting) or displays signs of cognitive impairment. But the triggering events just start the clock ticking on your waiting period before your coverage actually kicks in. Many policies have a 60- or 90-day waiting period -- also called an elimination period -- and that may be calculated in different ways. Choosing a longer elimination period holds down premiums. But when it comes time to file a claim, many families regret their choice, Some companies offer a zero-day waiting period for home care even if you have a longer waiting period for benefits in an assisted-living facility or nursing home. Other insurers offer an inexpensive policy rider that allows you to eliminate the waiting period for home care.

• Keep Your Policy in Force - When someone is starting to show signs of dementia, it isn't unusual for his or her unpaid bills to pile up. If one of those bills is a long-term-care premium notice, the policy could lapse for nonpayment right before an individual needs it. Insurers generally allow you to designate someone for backup notification if you haven't been paying your premiums. In some cases, the policy can be reinstated even after it has lapsed.

• Appeal Claim Denials - Most insurers have a multilevel appeals procedure. Some also offer an independent review process. You'll strengthen your case if you gather paperwork and keep detailed records of every phone call. "The number-one reason claims are denied is because the patient has not satisfied the activity-of-daily-living requirements," says Laurene Polignone, assistant vice-president of claims for John Hancock.

For more information see the full article at: http://www.kiplinger.com/magazine/archives/2009/05/how-to-file-long-term-care-insurance-claims2.html?kipad_id=2

-Adapted from “Make Sure Your Insurer Pays Up; Long-term-care paperwork can be overwhelming. here's how to cut through the red tape.” By Kimberly Lankford, From Kiplinger's Personal Finance magazine, May 2009; linked from ElderLawAnswers, May 07, 2009.

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