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You planned ahead. You saved money, made smart investments and decided to buy long term care insurance to take care of your needs when you got older and could no longer live at home or care for yourself. And now the time has come for all of that planning and preparation to pay off. Perhaps you need 24-hour nursing care or just a little extra help managing your daily tasks. If you bought a long-term care insurance policy, those expenses should be covered, but first you have to make a claim.

Making a claim on an LTC policy is a complicated process, but if you’re organized and prepared, it’s not difficult. Paying close attention to the details and staying involved will help your claim go through quickly and efficiently.

1.     Read your policy.

Before you do anything, read your policy to determine whether there are any requirements you need to meet or any clauses that could delay payment on your claim. For example, some insurance carriers reserve the right to request an additional assessment from another doctor to confirm whether the insured is chronically ill and in need of long-term care. Your policy will also outline the specifications for choosing a long-term care facility. In most cases, you can call the insurer to confirm the facility you’ve chosen is covered (document all of your conversations, including date, time and the representative’s name) or you can work with a service contracted by the insurer to find the right placement.

2.     Pay close attention to the dates.

All long-term care policies include an elimination period, or a specific number of days that must pass before policyholders can make a claim on the policy. The elimination period can range from 45 to 180 days, during which time you are responsible for paying for all of your long-term care expenses. Confirm the length of the elimination period with the insurer, including whether the period is based on calendar days or service days. Prepare to file your claim as soon as you are eligible, as most claims take up to 60 days to process.

3.     Documentation is everything.

Every insurance carrier has its own specific process for filing claims, but all require documentation that the claim has merit. Review your carrier’s claim process and begin collecting the documentation proving that long-term care is necessary. This will most likely include a copy of the assessment from a qualified physician that you or your loved one has a chronic illness or other condition that prevents you from living on your own, as well as any additional assessments required by the carrier, proof that the long-term care facility meets the requirements of the carrier and financial information and bills documenting the costs of the care. Make copies of everything you submit for your own files, and use traceable means of submitting the claim to prove when information was submitted. In the event there is a dispute, having copies, confirmation numbers and the names of people you spoke with can help clear up any confusion.

4.     Follow up regularly.

Insurance companies are busy places, often processing hundreds, if not thousands, of claims every day. Stay on top of your own claim by calling the company at least once a week to check on the status and confirm that the carrier has received all necessary information. Taking control of your own claim allows you to address any potential problems before you face any major delays, and it provides peace of mind that things are moving along.

5.     Get help.

Making a claim on your long-term claim insurance is a relatively straightforward process, but you may have questions. Get help from a qualified individual who can walk you through the process. Ask your carrier if they have an advocacy service that helps with claims, or visit your local agency on aging for help. In some cases, the agent who sold you the policy can assist with a claim or at least point you in the right direction for help. With thousands of dollars at stake, do not leave your claim to chance or guess how to handle questions or requirements that you don’t understand.

Every insurance company has its own process for filing a claim, and its own requirements for documentation. Do not be afraid to ask questions about the process and what needs to be done, and take care to keep detailed records. If you follow the steps laid out by the carrier, the claims process should be relatively simple and straightforward.

About the Author: Joe Houston works with seniors and their families in his community to help them navigate the often complex world of insurance coverage. A certified financial planner, he has helped dozens of families gain peace of mind by working with them to create plans that cover all of their retirement needs.


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