Top Long-Term Care Insurance Questions Answered by the Experts

Long-term care insurance can offer exceptional peace of mind, but utilizing those benefits can end up being a confusing experience for older individuals and their family members. To help guide families through this process, our senior care experts offer this helpful overview.

Exactly what services are covered?

Before filing a claim, it is essential to carefully read through a copy of the long-term care insurance policy so that you can gain an understanding of the kinds of services the policy covers. If you do not have a copy of the policy, get in touch with the carrier to ask for one.

Even though all policies differ in what they cover, long-term care insurance usually covers non-medical services at home, provided support is required with a minimum of two or more activities of daily living, or the policyholder has been diagnosed with some kind of cognitive impairment, such as Alzheimer’s disease. Examples of the types of care that long-term care policies might cover include:

  • Personal hygiene needs, such as showering, bathing and getting dressed
  • Ambulation and transfers
  • Toileting and incontinence care
  • Preparing meals and feeding
  • Household chores
  • And others

If you or a senior loved one needs help with understanding the details of the policy, an insurance agent, elder care attorney or financial planner may help.

Are all of the costs of care covered?

While individual plans vary, each plan details the allowable monthly coverage, which is identified as the “present daily allowance,” and frequently includes a lifetime maximum cap. Policies also generally identify a designated duration of time during which the benefits are accessible, such as five years, or if the insurance coverage is effective for the balance of the policyholder’s lifetime.

It is also important to review the long-term care plan’s elimination period. The elimination period is the time during which the cost for care needs to be paid out-of-pocket to begin with, until a set amount of time has passed. While some plans specify a zero-day elimination, which means that cost for care and coverage start immediately, other policies might require up to 120 days of care first.

Select your care provider carefully.

If you plan on submitting a claim for long-term care insurance, it’s critical to work together with a home care company which has experience in billing long-term care insurance providers; otherwise, there is the potential that the claim may not be fully reimbursed. Stay Home Care, the top provider of senior care in Nashville and surrounding areas, has experience with helping families obtain their long-term care insurance benefits and can provide the documentation necessary to help clients file claims correctly.

How are claims filed?

To file a long-term care insurance claim, the documents below are normally required:

  • A claimant’s statement (or policyholder statement) outlining the reasons for the claim
  • A physician’s statement provided by the doctor, confirming that care is needed
  • A prescribed care plan and nursing evaluation
  • A provider statement, completed by the home care agency
  • An authorization form

Once completed and submitted, a phone interview is arranged with the insurance company’s claims department, and then the claim is either approved or declined.

If you are seeking to access home care services through a long-term care policy, contact Stay Home Care today at 615-964-7726. You can feel confident in knowing that we have years of experience in not only delivering specialized care in the comfort of home, but also in helping families with long-term care insurance claims and receiving the most out of their plan. To learn more about our services for home care in Nashville and the surrounding communities, please visit our Locations Served page.

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