Long-Term Care Insurance Claim Activation

Most long-term care insurance policyholders purchase their policies years or even decades before it’s time to use them. Most policyholders purchased their policies and quickly filed them away, leaving most policies untouched for years. Given the time span from when a policy is first purchased to when it’s time to start using the policy, it’s not uncommon for insureds to have no idea what’s in their policy or how it works.

If you are finally at the point where it is time to activate your policy, you likely have a number of questions and concerns. You are probably wondering how the initiation process works, or who you can ask for help. The process can certainly be daunting.

Most policies display a toll free number on the front page. The number will direct you to your insurance company’s claim department. The department can answer your basic questions and provide some guidance. However, the extent of their assistance is very limited and oftentimes the information you receive from the insurance representative can leave you feeling even more lost than you were before you called.

If you feel unsure about how to proceed or are having problems with your insurance company, the law offices of Steven M. Dunn, P. A. have a team of specialists that can help. So give us a call today, and let us guide you through the process.

What are the steps I have to take before starting the activation process?

There are a number of preliminary steps the insured should take before beginning the activation process. The first step is to review and understand the terms and conditions of the policy. If an insured does not understand their policy, they should seek expert advice before moving forward.Once an insured understands the conditions and coverages in their policy, they can begin to craft a care strategy that will both fit their needs, and be covered under their policy.

Once an insured understands their specific policy they must make sure that the medical documentation is in order. They should speak with their doctor and discuss whether their records indicate either a need for assistance with activities of daily living or whether there is evidence of a severe cognitive impairment.

The next step is to come up with a care plan that meets their needs. The insured should consider all the options including home care, or assisted living. If the insured determines that home care is the best option for them, they should research the best home care agencies in their area with a focus on agencies that have experience with long-term care insurance claims. If assisted living is the best choice, the insured should speak to an experienced placement professional who can guide them to the best facilities in the area. Once a plan has been decided, the insured can start to move on to the activation stage. 

While the insured can certainly undertake these steps on their own, it is beneficial for them to rely on expert help during this process. A long-term care insurance attorney will be able to help create the best care strategy that meets their care needs and that also fits with the terms of the insured specific policy. Additionally, a long-term care insurance attorney will be able to review medical documentation, and make recommendations for home care agencies and assisted living. A long-term care attorney will assure that all the pieces are in place before moving to activation. If you are considering activating your long-term care insurance policy, call the offices of Steven M. Dunn, P.A today.

How do I file a long-term care insurance claim?

If you are a policyholder or power of attorney for an insured looking to activate a policy, the following steps should be taken;

First, you should start by contacting the insurance company and requesting a claim form. You can generally get one online or by requesting one over the phone. If you are not the policyholder but are a friend or family member looking to help activate a policy, then you must provide the insurance company with a copy of the power of attorney documents, the policy number, and identifying information to confirm the policyholder’s identity.

Once the insurance company receives the claim forms, they will contact the facility where the policyholder resides or the home care agency providing care. The insurance company will gather information on the policyholder’s functional and cognitive status. The insurance company will also schedule a third-party nursing visit to verify this information.

Once all this information is received, the insurance company will determine if the policy owner meets the policy’s requirements and issue a letter to this effect.

All of these steps are crucial to the activation process. The most important step of the activation process will be the third-party assessment. Most claim denials are based on mistakes made during the third-party assessment portion of the process.

Satisfying the Elimination Period for a Long-Term Care Insurance Claim

Most long-term care insurance policies have an elimination period provision.The elimination period must be met before a policy will payout benefits. An elimination period is a policy-defined number of days that the policyholder must be eligible for benefits under the policy and must pay for covered services out of pocket. This is the equivalent of a deductible in a health insurance policy.

Additionally, you or the person who holds the power of attorney must submit written invoices to the insurance company for covered services as proof that the elimination period has been satisfied.

If not managed properly, the elimination period can be a very costly period in the activation process. The most common mistakes will come from not understanding what counts towards the elimination period, or not managing this period in the most cost efficient manner.

If you are beginning your activation process and starting to work through your elimination period, it is imperative that you speak to an expert. A long-term care insurance attorney can confirm that the services you are paying for out of pocket do in fact count towards the elimination period and can also provide the most cost effective money saving elimination period strategy.

If you are starting the activation process and have a policy that requires an elimination period before benefits can be paid, please call the law offices of Steven M. Dunn, P. A., and request a consultation. We have the knowledge and expertise to handle any matters related to filing a long-term care insurance claim and the elimination period.

How Our Attorneys Can Help You with Long-term Care Insurance Claim Activation

At Steven M. Dunn, P. A., our attorneys can help you with your long-term care insurance claim activation from beginning to end. First, we will conduct an in-depth review of your policy to determine basic information like how much your benefit is, what coverages the policy provides,  how long benefits are supposed to last, what the benefit triggers are, whether there is a waiver of premium etc. Then, we will work with you to craft the best, personally tailored care plan to meet your needs. Once a plan is agreed on, our team will put together the necessary documents to file a long-term care insurance claim and take all the steps required to assure your long-term care insurance claim is approved.​

Leave your long-term care insurance matters in our hands; schedule a consultation today to learn more.