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How to Simplify the Long-Term Care Insurance Process

long term care insurance

When an older loved one begins to exhibit signs that care at home may be best, family members are faced with the tedious process of searching through paperwork to determine if that long-term care insurance policy, secured years ago, will be of any assistance now. Once the documents are dusted off, there are often more questions than answers:

    • What services does the policy cover?
    • How much funding is available for services?
    • What’s the process for filing claims?

Our Chicago memory care and home care experts have compiled the information you need to access the benefits to which you’re entitled.

What services does a long-term care insurance policy cover?

Although each person’s plan is unique, long-term care insurance typically covers the following types of non-medical services at home, as long as assistance is needed with at least two activities of daily living, or there is a diagnosis of some type of cognitive impairment (such as dementia). Examples of activities of daily living are:

    • Personal care needs, such as showering/bathing, getting dressed, and other hygiene and grooming needs
    • Ambulation/transfers
    • Using the toilet and incontinence care
    • Preparing meals and feeding
    • Housekeeping and related tasks
    • And others

How much funding is available for the services needed?

The long-term insurance plan will outline the allowable coverage amount, which will be noted as a preset daily allowance, oftentimes with a lifetime maximum cap. The policy will also designate a particular length of time that the benefits are available, such as five years, or if coverage will remain in effect for the duration of the policyholder’s lifetime.

You will also need to review the plan’s elimination period, when care costs are paid out-of-pocket until a set amount of time has passed or number of visits completed. Although some plans include a zero-day elimination, meaning coverage begins immediately, others may require as much as 120 days of care before coverage kicks in. In addition, most policies include credit for time spent in rehabilitation which can help satisfy the elimination period more quickly and cost effectively.

What’s the process for filing claims?

When filing the first long-term care insurance claim, a packet of information must be completed, including documents such as:

    • A policyholder statement (or claimant statement) which outlines reasons for the claim
    • A doctor’s statement to confirm that care is needed
    • A prescribed care plan and nursing assessment
    • A provider statement, completed by the home care agency
    • A client confidentiality authorization form
    • Assignment of Benefits – if choosing to have the home care agency handle financial aspects of the benefits

Once this packet is completed, a phone interview will be scheduled with the insurance company’s claims department, then a nurse assessment and finally the claim will be either approved or denied.

At SYNERGY HomeCare of Chicago, we have vast experience in helping seniors and their families understand and work through the daunting long-term care insurance process. We initiate claims and follow the process through from start to finish. We can even do an assignment of benefits, meaning seniors aren’t required to collect funds first from their insurance provider, but payments are made simply and seamlessly directly to us for services provided, removing that burden from the client and family.

Contact SYNERGY HomeCare’s Chicago aging care experts for a consultation or for answers to any additional long-term care insurance questions, and let us help you obtain both the in-home care services you need, and the appropriate reimbursement from your insurance provider. Call us any time at (773) 868-3183 for assistance.