Tuesday, July 16, 2019
Paying for long-term care (for yourself or a loved one) can be a financial challenge if you don’t know the legal options available to you. How well do you understand your long-term care insurance? Would your insurance company deny your long-term care claim? Let’s make sure the answer is no.
Be sure to have a copy of the policy so you can review it carefully. Older policies may only provide for “Nursing Home” benefits that include payments for room and board or “Home Health Care” that includes a qualified Home Health Care Provider. Newer policies often provide benefits for both.
Older policies focus on “medical necessity.” Newer policies refer to the ability to perform activities of daily living (ADL). If the patient can’t eat, bathe or dress without assistance, you’ll probably meet your policy’s criteria for long-term care benefits.
Still, not performing activities of daily living may not be enough. A physician must first confirm that the patient cannot perform their ADL’s. Then, the doctor must recommend that the patient should go to an appropriate long-term care provider.
Once you see that the doctor has made recommendations in an established “Plan of Care” that matches the type of care covered under your policy, the claims process can be started.
In the claim, take time to add more details required, along with all evidence that could add to your case. Include the doctor’s statement that long-term care treatment is necessary and then submit your claim. Once it’s filed, communicate everything in writing, if possible, and file all communication in an easily accessible place.
Next, your claim will be assessed in person or by phone to verify the need for long-term care. The long-term care provider will also have a role in the claims process, filling out their own forms to prove they qualify for eligibility with your specific policy.
Most insurance companies pay claims on a timely basis, yet others may stall claims, causing great frustration. Don’t let your insurance company take advantage.
If you think that your insurer has unfairly denied your claim, a reputable attorney experienced in the intricacies of this type of law should be called.
Are you considering long-term care for yourself or a loved one? Call Concierge Care today at 888-205-9940. Concierge Care may be able to help.