Tips for getting your long term care insurance claims approved and paid • Benzinga

Compare Medicare Advantage plans and quote side-by-side for the best rate here.

Millions of seniors have purchased long term care insurance over the past 30 years. This special coverage is designed to reimburse or pay for eligible care that is needed as you age. Benefits covered can pay for care at home, in an assisted living facility or in a qualified nursing home.

When care is ultimately needed, submitting and paying a long term care insurance claim isn’t always straightforward. Unlike health insurance or Medicare, the claims processes are not uniform. Either way, doctors’ offices and hospitals have billing specialists whose job it is to submit claims on your behalf. Medical billing codes are standardized and the patient rarely has to get involved.

This is not the case when it comes to long term care insurance claims. Here are some tips to help you if you or an aging loved one with coverage needs care.

Long-term care insurers pay claims

Currently, between 6 and 7 million Americans have some form of long term care insurance coverage. This protection is generally taken out between the ages of 50 and 70, with claims generally occurring when the insured reaches their 80s or 90s.

In 2021, some $12.3 billion was paid out to more than 336,000 people covered according to the American Association for Long-Term Care Insurance (AALTCI). The amount has increased every year depending on the organization. In 2018, insurers paid out $10.3 billion to just over 300,000 policyholders.

It all starts with the long term care insurance policy

At one time, as many as 100 different insurance companies offered long term care insurance policies. Although many factors were standardized, each company generally had a unique policy language. This contractual wording ultimately governed what the particular policy will pay.

When care is ultimately needed, the first step is to research and obtain a copy of the policy. Having the document will ensure that you get every claim dollar you deserve from your policy. It can also help avoid a claim denial. A typical policy can be 35-40 pages long, and you’ll need to read it all to understand exactly what type of care is covered and how to qualify for benefits (sometimes called “benefit triggers”).

If you think your aging parents may have long-term care insurance coverage but can’t find a policy, the best place to start is in their bank account. Look for automatic insurance premium payments deducted from the account.

Most Common Reasons Why Claims Are Denied

When qualifying care is needed, prompt reimbursement and avoiding a denied claim are your primary goals. The main reasons for refusal are to provide the insurer with incomplete information. A second common reason is submitting documentation that does not exactly meet the requirements of your specific policy.

Claims may be denied if the type of care does not meet the policy’s definition of covered care. Additionally, claims are routinely denied if your medical documents don’t match your policy’s specific triggers.

If a request is denied and you believe it is valid, you should appeal the denial. Many well-meaning medical and care providers don’t understand exactly what the long term care insurance company needs to see to approve a claim.

Find help with long-term care claims

Given the complexity of filing a claim or the time it can take, an increasing number of people are asking for help. Professionals typically charge for full support with fees ranging from $2,000 to $5,000.

According to the AALTCI’s Long Term Care Insurance Claims Assistance Center, adjusters will usually provide follow-up answers to simple questions. Since long-term care claims can easily run into the hundreds of thousands of dollars, being persistent and acting early can go a long way.

Comments are closed.