It is a wise decision to take a long-term care insurance while you’re still earning as it can be beneficial for you after you retire and grow older. Making use of the benefits can be a great move and this is possible only after filing a claim. There are a series of steps that need to be reviewed and it is very important to be aware of the acquisition process.
Let’s examine what you need to do.
Policy review
Before contacting your insurer, get a copy of your policy and review it thoroughly. Many patient’s family members, children and lawyers spend months trying to get their bills paid. Try to avoid any traps that can allow the insurer to avoid paying.
When does the policy come into effect?
Try and determine when your policy kicks in. All policies include a deductible or an elimination period of 20, 60, or 90 days. Some caregivers use calendar days before your policy comes into effect. Others use service days wherein only the days where you paid for a health aide are counted toward the elimination period. It’s important to know when your policy comes into effect so you can understand what and how much of the bill you’re footing.
Tests that trigger your benefits
The conditions that enable your policy to kick in may differ from one policy to the next. However, you generally have to prove cognitive impairment or the inability to perform certain key daily tasks or acts of daily living (ADL’s). These include:
- Bathing
- Dressing
- Toileting
- Eating
- Continence
- Transferring
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If you are unable to perform two or more of the above, you are eligible to claim the insurance. When you make a call to your insurer, try to have a physician’s report that reflects what you’re saying. It is important that an advocate or a doctor can verify these disabilities and the insurer can always contact the claimant’s representative as the claimant himself may not be in a condition to give an adequate response.
Caregiver requirements
Study who exactly qualifies as a caregiver on the policy document. It could be a licensed individual who works for an agency even though the claimant only needs a personal care aide. If you have a caregiver that doesn’t meet these requirements, you may need to change the caregiver.
Contact the insurer
After you have studied the fine print, call the insurer and file a claim. Make sure you can back up everything you’re saying with verifiable documents from certified physicians. Keep a log of all communication between yourself and your insurer. If your cover has a provision for care coordinator services, take advantage of that as they will be able to get you the best possible deal.
Submit documents and get assessed
The final step is to submit the relevant documents and get assessed. This will allow you to begin the claims process. The claimant should be in the presence of a family member so everything is done in a fair and transparent manner. If everything goes well, you should start receiving your benefits.
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