Long-term care insurance benefits can provide exceptional peace of mind, but accessing the policy benefits can turn out to be a confusing experience for older adults and their loved ones. To help families navigate the process, Hillendale Home Care, the experts in home health care in Walnut Creek, provides the following tips.
What services are covered?
Ahead of filing a claim, it is important to thoroughly read through a copy of the long-term care insurance policy in order to understand the types of services the insurance policy covers. In the event that you don’t have a copy of the policy, reach out to the carrier to request one.
While all policies differ in what they cover, long-term care insurance benefits usually cover non-medical services at home, provided assistance is needed with a minimum of two activities of daily living, or the policyholder has been clinically determined to have a cognitive impairment, such as dementia. Examples of the types of care that long-term care policies may cover include:
- Personal care needs, for example, bathing/showering and getting dressed
- Incontinence care
- Meal preparation and feeding
- Ambulation and transfers
- Household chores
- And others
In the event that you or your loved one needs help understanding the information in the policy, an elder care attorney, insurance agent, or financial planner may be able to assist.
Are the costs of care fully covered?
While individual plans vary, each plan outlines the allowable monthly coverage, usually identified as the “present daily allowance,” and often has a lifetime maximum cap. Policies also typically identify a certain amount of time for which the benefits are available, for example five years, or if the coverage is in effect for the remainder of the policyholder’s lifetime.
It’s also essential to find out the long-term care plan’s elimination period. The elimination period is typically the time during which the cost of care is paid out-of-pocket initially, until a set period of time has passed. While some plans specify a zero-day elimination, meaning cost of care and coverage begin immediately, other policies may require up to 90 days of care first.
Select your care provider carefully.
If you plan on filing a claim with long-term care insurance, it is vital that you partner with a home care agency that has experience with billing long-term care insurance providers; otherwise, there is the possibility that the claim will not be completely reimbursed. Hillendale Home Care is knowledgeable and experienced in long-term care insurance benefits and can provide the documentation clients need to file efficient claims.
How are claims filed?
To file a long-term care insurance claim, the documents that are typically required are as follows:
- A claimant’s statement (or policyholder statement) detailing the reasons for the claim
- A physician statement completed by the doctor, verifying the need for care
- A prescribed plan of care and nursing assessment
- A provider statement, completed by the home care agency
- An authorization form
Once completed and submitted, a phone interview is scheduled with the insurance company’s claims department, and after that the claim is either approved or denied.
If you are considering accessing home care services through a long-term care policy, contact Hillendale Home Care today at 925-933-8181. You can feel confident in knowing that we have many years of experience in not just providing exceptional care within the comfort of home, but also in helping families with long-term care insurance claims get the most out of their benefits. For more information on our top-rated care services in Berkeley and the surrounding areas, reach out to us today.