Helping with Long Term Care Insurance

Families often call us for guidance on their Long Term Care Insurance. It can be difficult to navigate the claims process not knowing if your loved one is qualified to receive benefits. Here's one story:

Mrs. Thompson called asking for help in starting a claim for her husband not knowing whether or not they would be covered. We met for a consultation and were able to determine that although her husband is basically ambulatory, his dementia has progressed and is unable to perform Activities of Daily Living (ADL's). ADL's include bathing, dressing, eating, transferring and toileting. When reviewing the policy we found they would need to pay for caregivers out of pocket for 60 days before insurance would start to reimburse the cost. We encouraged the Thompsons to start a claim by calling their insurance company and requesting a comprehensive assessment, including ADLs. We then connected them with a local caregiver company to initiate their services. This company would also be able to submit receipts to show the 60 days of payment, satisfying the terms of their policy for the elimination period. We accompanied the Thompsons during their assessment to ensure that all of their care needs were being recognized. The assessor did not initially see the need for his assistance with bathing and toileting until we asked Mrs. Thompson to role play their process in the bathroom and how much help she was giving. Thankfully, we had a great nurse who agreed with our assessment regarding Mr. Thompson's ADL needs. We also raised safety concerns regarding ambulation because his gait was unsteady, requiring a caregiver to be present to assist in case of a fall. The assessment came back 30 days later and they were approved for 24/7 caregiving and their policy is reimbursing for all their care costs. 

Long-Term Care Insurance policies can be challenging to understand regarding what qualifies for care and reimbursement and it is essential for our clients to receive the long-term care insurance benefits they deserve. If you have questions about your long-term care insurance policy or are wondering if your loved one is being reimbursed for the number of hours required for their safety, please give us a call. We would be happy to meet with you to review to review your policy and set up an assessment with one of our experts.