File a Long Term Care Insurance Claim in Los Angeles, CA

If you’ve purchased a Long-Term Care Insurance (LTCI) policy and are ready to make a claim with that policy to receive services for Home Care, there is a process to keep in mind that will help expedite your requests. Getting the help you or a loved one needs for ongoing regular care can be achieved without major stress. A Los Angeles Long Term Care Management company can help to walk you through each step. 

Paying for Home Care with a Long Term Care Insurance Policy

Long-Term Care insurance covers the costs of care needed due to chronic illness or disability. Medicare, MediCal or a combination of both (Medi-Medi) are designed to pay your medical health care costs, but they do not cover non-medical expenses that fall under home care. In-home care consists of services like:

• Basic personal hygiene
• Companionships
• Dressing
• Meal planning and preparation
• Light housekeeping and laundry
• Transportation to appointments
• Medication reminders 

Long-Term Care Insurance policies are built to reimburse you for these services you might require, whether it be in the home or at a care facility.

Learn more: How Long Term Care Insurance Works

How to File a Long-Term Care Insurance Claim

A claim can be filed by anyone who has been given authorization; such as a Durable Power of Attorney, i.e. when someone becomes incapacitated. 

The first step is to contact the insurance company that is handling the Long-Term Care Insurance policy in order to gather all the specifics of the coverage. If you understand what the policy covers, you are more apt to avoid being denied. 

Here is some important information you will want to know regarding the policy:

• What conditions must be first met? There are many insurance companies and many different types of policies. Make sure you know what criteria must be met in order to be reimbursed.
• Are there any out-of-pocket expenses that will be required to be paid before coverage begins? Or an “Elimination period”? Many policies require you to pay out of pocket for a certain amount of time (30, 60, or 90 days) before the insurer will reimburse you for the care needed.
• Make sure a licensed health care provider can provide proof that help with Activities of Daily Living (ADL) is needed.
• What is the duration of the policy? Some policies have benefits that pay for yearly terms, while others have a maximum dollar amount that is paid.
• How much will the policy pay?
• What specific kind of care does the policy cover?
• Are there any issues that will keep the insurance company from reimbursement? Some companies will not reimburse a policyholder whose care is a result of self-inflicted injuries or drug and alcohol abuse. 

What Kind of Information Should You Have Prepared When Filing a Claim?

When you file a claim, the insurance company will review the care plan and other information sent by doctors and specialists. They might require a nurse to do an evaluation before approving the claim. 

Most insurance companies will require the following information:

• A policy number
• The policy holder’s address and last four of their social security
• A power of attorney
• The Name, address and phone number of the facility where the policyholder resides  
• Name and phone number of primary physician. Those who are providing care will be asked to provide the type of care being given as well as start and end dates, and the Plan of Care. 
• Release form of information for HIPAA compliance