The Long-Term Care Insurance Claims Process

Choosing the right carrier for your long-term carerequired you may need to sign a "Release of
needs is important. You want to be assured that theInformation" form.Based upon an assessment of the
company is strong financially and will be there wheninformation obtained, benefit eligibility is determined
you need it. Even though you may not be utilizing the- A care coordinator will develop a comprehensive,
claims process for many years, it is important topersonalized plan of care to meet your needs and
understand that it isn't the nightmare that the newspreferences.
sources like to make of it.- A care coordinator will provide advice about
The need for long-term care is often a stressful timeresources in your area
for families and can have a significant financial,- A care coordinator will help implement your plan of
physical and emotional impact on everyone involved.care and will stay in touch with you as your needs
The top carriers design their LTC insurance policieschange.
not only to help protect families against the high cost- A care coordinator will provide you with the date of
of care, but also to provide valuable advice,authorization
resources and support at the time of claim. As an- Reimburse for your services: you or your provider
owner of a long-term care insurance policy, you andwill send in itemized invoices, and they will be
your family can talk to the service specialists at anyprocessed within 15-30 days.
time. You may have your questions answered inThe carriers can usually help most when you contact
regards to your coverage or about long-term care inthem before services are in place-whether that
general.means helping your find the right care in the location
How the claims process works:your prefer or enabling you to extend your benefit
Care is usually needed when:dollars by leveraging provider discounts.
- Assistance is needed with two or more activities ofAccording to the 2009 Long-Term Care Insurance
daily living-eating, bathing, dressing, using the toilet,Sourcebook,
continence, or moving around.Percentage of Long-Term Care Insurance Claims paid
- Experience episodes of confusion, dementia,to:
unsteadiness, or fallingWomen 65%
- Needs substantial supervision due to a severeMen 35%
cognitive impairmentPercentage of Long-Term Care Insurance Claims paid
Know the Toll-Free number of the carrier and thefor:
number of your agent.Home Care 42.0%
A care coordinator will be assigned to you to act asAssisted Living 27.5%
your advocate. The following is basically how theNursing Home 30.5%
claims process works:Age At Which New Claims Were Opened:
- A care coordinator will visit the home and reviewAge 50-59 1.5%
medical history, the benefits of your policy and yourAge 60-69 7.0%
current care needsAge 70-79 30.5%
- A care coordinator will contact your physician/IfAge 80 -Over 60.