Getting Your Money: How Claims Are Processed

As a general starting point, it's important to mention that every Long Term Care policy has its own contractual terms, which are the letter of the law on how your policy works.  For someone just starting to shop for coverage, we intend to illustrate a few examples of how some policies on the market work when it comes time to make a claim.  If you are able to better understand how you are able to get claims payments made, you are a more informed shopper.  At the end of the day, consult your specific policy for details, and use this as a primer.

Reimbursement

Virtually all policies sold today are "reimbursement" which means that your actual LTC expenses are covered up to your daily or monthly benefit amount.  No more, no less.  There were once policies on the market called indemnity policies that would cover a set benefit amount regardless of actual expenses.  These policies were more expensive and more prone to abuses, so the conservative-minded companies quit selling these options early on and by 2013, there were no mainstream LTC policies on the market that had indemnity benefit definitions.

Privileged Care Coordination: What a Claim Looks Like

One of the most popular policies on the market includes built-in (but completely optional) Care Coordination service.  Upon activating policy benefits, the company will send a Geriatric Nurse to your home to assist with initiating the claim.  At a time of need, having a skilled, licensed professional is really helpful.  This expert will be able to provide names of at least three in home providers (or facilities if that need arises) and can help with the claims paperwork.

Monthly Call
Your Care Coordinator's duties include making a monthly call to assess ongoing needs.  There was a recent example where a man was on Long Term Care claim and the care coordinator uncovered a nutrition issue on one of these monthly calls.  Mr. Jones was needing LTC and Mrs. Jones was covering meals.  It turned out she was having trouble meeting her husband's nutritional needs, so the company sent out a nutritionist once a week to cook meals to freeze, so Mrs. Jones could then take them out and warm them up through the week.  These are examples of how having an extra "team mate" watching out for you can be of the utmost importance.

Supplemental Information

Additional information on Getting Your Money: How Claims Are Processed.

Did You Know?
Some insurance policies include the cost of Care Coordinators as a seperate benefit from your "pool of money" while others deduct the cost of Care Coordination from your pool of money.  This is not a huge difference, but may set some companies apart from others when really comparing the finer details.

Care Coordination
The use of a care coordinator is usually optional, but can provide value if chosen.

 

"I was concerned I may not qualify due to some arthritis treated by medications. Once I spoke with LTC Tree, I felt like I had a plan of companies that would accept me. Two months later, my application was approved and after a short Q&A with my agent I sent in the premium and put coverage in force. All is well.

Don B., Ft Myers Florida

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