By: Bill Borton, Managing Principal, W.R. Borton & Associates

January 27, 2016 10:23 am EST
mature woman

A long-term care insurance policy can help cover the costs of care in a nursing home, an assisted-living facility, an adult day care center or at home.

Helping a parent, or other loved one, with a long-term care insurance claim can be a daunting proposition. If you follow these steps, you're more likely to get through the claims process smoothly:

1. Determine what triggers benefits

Most policies pay only if the insured needs help with at least two out of six activities of daily living (such as bathing or dressing) or there is evidence of severe cognitive impairment. But the requirements for making a claim vary. Work with your parent or loved-one’s doctor to provide the information the insurer needs.

2. Find out about home care requirements

If you plan to provide care for your parent at home, call the insurer to find out about requirements for payouts, especially before you hire a caregiver to come into the home. Some insurers require home caregivers to be licensed or from an agency. A few pay benefits even to relatives who provide care. Most insurers have care coordinators who can help you search for caregivers or facilities.

3. Understand the waiting period

Most long-term care policies have waiting periods of at least 60 days. Some policies have a zero-day waiting period for home care but a longer waiting period for assisted living or nursing homes. Others count every calendar day from the time your parent meets the requirement for needing help with activities of daily living or the cognitive impairment requirement, even if he or she didn't receive care every day.

Still others count only the days on which your parent or loved-one received care, which can extend the waiting period. If that’s the case, to speed things up, you may want to have a caregiver come in for a shorter period for more days rather than a longer period for fewer days.

4. Keep track of calls and the paperwork

That includes forms you submit and communications with the care providers or facilities and the long-term care insurer. Sometimes payouts can be delayed because of paperwork issues. Keep records of all phone calls and dates that you or the doctor or the facility sent information, and follow up to make sure the paperwork has been received.

Also, ask the insurer or your broker if there is anything you can do to streamline the process.  Some insurers will arrange direct billing between the facility and insurer.

5. Appeal a denied claim

If you have a dispute, work through the insurer's appeals process, and if necessary, contact your state insurance department for help.

The views and opinions expressed herein are those of the author(s). Core Compass’s Terms Of Use applies.

About the author

Bill Borton is Managing Principal of W.R. Borton & Associates, a specialist in asset protection strategies and extended-care solutions for high net-worth clients. Bill's firm develops individually tailored solutions in coordination with each client's financial, tax and estate planning advisors to transfer this long-term care risk using a wide range of available insurance products.  Bill can be contacted by phone at 856.817.6100, by email at info@wrborton.com or through the online form on his website.

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