subject: How Long Term Care Insurance Claims Work? [print this page] Most long term care insurance policies trigger claims when either of the two events occurs: severe cognitive impairment and loss of two of daily activities or ADL. Heres how claims process work:
Inability to Perform Activity of Daily Living (ADL)
Under federal and state law, activities of daily living include bathing, continence, dressing, eating, toileting, and transferring. It is inclusive of cooking and bathing.
During the time of claim, the insurance company will assess your inability of performing activities under ADL.
The best LTC policies pay benefits for two or more ADLs without assistance, while not worth considering policies oblige applicants to get assistance with more than two. Beware of policies that ask you to drop more ADLs for home care or care in assisted living facility.
Severe Cognitive Impairment
Cognitive impairment means a persons intellectual capacity is impaired to the extent it has affected his or her short-term and long-term memory. Alzheimers or dementia falls under this category. The condition must be severe to trigger the benefit and to receive supervision. A cognitive impairment assessment will be performed to determine how severe the condition is.
The Plan of Care
After you pass the ADL and/or cognitive impairment assessment and become eligible for benefits, a plan of care will be followed and developed. The plan of care is a written individual plan, directed by a licensed doctor, registered nurse, or licensed social worker, which determines the type of care and frequency of LTC services you will need for your condition. Federal and state laws mandate tax-qualified policies only the one ti provide benefits for qualified long term care services that are embraced in your Plan of Care.
Also, if you become eligible, some policies may even incorporate homemaking servicessuch as cooking and cleaning in your benefits. These activities are included in Incidental Activities of Daily Living or IADLS.
How to File a Claim
The must provide three sources to the insurance company: the policyholder, the provider, and the policyholders physician. Make sure everything that you have stated from the three sources is accurate and real, unless you want your claim denied or delayed.
You may consider help from a care coordinator of LTC insurance expert to assist you with the claims process. Before purchasing coverage, do a research on how the company handles its claim process to its policyholders. If the company has good experience in claims, then rest assured youll get a good service too.
What if my claim is denied?
If you follow the claims process properly and provide legit information, your claim will be less likely denied. Most states have passed laws that give high penalties to insurance companies that deny a legitimate claim. If your claim is denied, you should seek help from attorney or financial expert.
Care Coordination
Care coordination is defined as service that helps manage the persons care with the assistance from family, friends, care givers, and health care practitioner. Care coordinators are health care practitioners that assess the persons needs, determine the type of care needed, and assist the family in obtaining the care they need.
by: Jenny Nielsen
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