If your loved one wants to use a long-term care insurance (LTCi) policy to help pay for home care, it can be challenging and time-consuming figuring out what the policy covers and how to unlock the benefits.
Dealing with a long-term care insurance policy can be a struggle, yet your loved one paid premiums for years so you want them to receive the benefits they are entitled to. Here are some helpful tips for unlocking benefits from an LTCi policy.
1. Ask the Right People the Right Questions
Not only do you have to ask the insurance carrier the right questions, but you have to ask them in the right way. Carriers may not be forthcoming with information so you must ask direct, specific questions such as:
- Does the policy cover home care?
- At what percentage? (Is it covered at 100% or 80%?)
- What is the daily policy maximum for home care?
Most customer service representatives do not understand the LTCi jargon. You might get different answers from different people, so be persistent and organized. Call back to ensure that what the first person told you was true. Some carriers employ “Benefit Analysts” who are more knowledgeable. Do your best to get transferred to such an employee.
2. Document Everything
If you need to appeal when the insurance carrier refuses to pay a claim (i.e., a “denial”) or only pay part of the claim (i.e., “short-pay”), you need evidence. Make sure you document everything. Always write down who you spoke with, what date, what time and exactly what they told you. Most carriers record their inbound customer service calls, so they can pull the call records as evidence of what their customer service representative told you.
3. Pay Close Attention to the Policy Details
Each policy has specific rules. Here are a few examples:
Elimination Period – Benefits will not be paid until the policyholder has fulfilled a certain amount of time (could be 30 to 100+ days) and provided documentation of care received during that time period. These periods can be counted as Days of Service or as Calendar Days. Elimination Periods may need to be satisfied more than once if too much time elapses between claims.
Start of Care – A policy might require that care starts within a certain timeframe upon the first claim being opened. For example, some policies require care to start within 15 days of the first claim being opened, otherwise the policy will only pay at 80% of the benefits going forward.
Caregiver Qualifications – A policy might require that caregivers have a certain license or certification such as: CNA (certified nurse’s aide), HHA (home health aide) or LPN (licensed practical nurse).
4. Best Practices for Submitting Claims – Make sure you follow the policy guidelines when submitting claims, such as:
Activities of Daily Living Cleary Marked – Adhere to policy requirements for the number of ADL’s (bathing, eating, dressing, toileting, transferring, continence management) that must be performed at each visit; ensure that the caregiver records on every claim form.
Signature Requirements – Does client, caregiver, agency, or some combination need to sign each claim form or activity log?
Submit Claims Weekly – Some carriers only review claims once a month. If you miss that cutoff, they will not review your claim until another month after that.
5. Enlist Experts
It can be a cumbersome process getting a long-term care insurance policy to pay for home care. That is why many families enlist experts such as FHS SeniorCare Payment Solutions. FHS has a team of billing experts who have been helping families with their policies for nearly thirty years. FHS can work directly with a family but in most cases they partner with a home care agency so that the burden of dealing with the policy is removed from both the family and the agency, allowing everyone to focus on what is most important: providing compassionate care for your loved one.