Filing a long-term care insurance (LTCI) claim can be daunting, especially when you’re unfamiliar with the process. Laura Lynn Morrissey, here, founder of SilverSavvy and prior owner of a busy homecare company. At SilverSavvy, we’ve guided hundreds of families through these challenges, ensuring they receive the benefits they deserve. One of the biggest surprises for many families? The elimination period and how it impacts when benefits begin.
But that’s not the only pitfall. Another often overlooked challenge is how claims are managed. Many insurance companies now outsource their claims management to third-party administrators, which can create additional layers of complexity. Let’s dive into this issue, along with other mistakes to avoid, to help you streamline your LTCI claim.
1. Misunderstanding the Elimination Period
The Mistake:
Many policyholders don’t fully grasp how the elimination period works, leading to unexpected out-of-pocket expenses and delays in accessing benefits.
What It Is:
The elimination period is essentially the waiting period before the insurance company pays out your benefits. During this time, you’re responsible for paying care costs. Policies typically require either:
- Service Days: Only days you receive qualifying care count toward the waiting period.
- Calendar Days: Every consecutive day after care begins counts toward the waiting period, regardless of whether care is provided daily.
How to Avoid It:
- Review Your Policy Carefully: Understand whether your elimination period is measured in service days or calendar days.
- Plan Financially: If your policy uses service days, the waiting period can take much longer than expected, as only days care is received count.
Example:
Imagine your policy has a 90-day elimination period:
- With calendar days, benefits start 90 days after care begins, whether you receive care every day or sporadically.
- With service days, only days you receive qualifying care count, meaning a 90-day elimination period could stretch over months if care isn’t provided daily.
SilverSavvy’s Tip:
We’ve seen families unintentionally extend their elimination periods by scheduling care sporadically. Working with SilverSavvy, we help families understand this critical distinction to avoid unnecessary costs.
2. Overlooking Policy Requirements for ADLs
The Mistake:
Failing to document the inability to perform Activities of Daily Living (ADLs)—like bathing, dressing, or eating—can result in denied claims.
How to Avoid It:
- Ensure your care provider tracks and documents the ADLs they assist with.
- Provide detailed, consistent records when filing your claim.
SilverSavvy’s Tip:
Our team works closely with families to ensure all documentation aligns with policy requirements, helping to avoid denials due to missing details.
3. Assuming Non-Approved Providers Qualify
The Mistake:
Using care providers who aren’t approved by the insurer can lead to denied reimbursements.
How to Avoid It:
- Verify that your chosen care provider is licensed and approved by your insurance company.
- If you’re unsure, ask SilverSavvy for help in identifying trusted providers.
SilverSavvy’s Tip:
Licensed and accredited providers are key to ensuring your expenses qualify under your policy. We connect families with pre-approved care partners to simplify this process.
4. Navigating Outsourced Claims Management
The Mistake:
Many insurance companies have outsourced claims management to third-party administrators, which handle claims for multiple insurance providers. While this approach helps insurers scale operations, it can lead to issues like misplaced paperwork or delays in communication.
What This Means for You:
Claims managed by third parties often involve multiple layers of processing. With large volumes of claims to handle, there’s a higher chance of:
- Misfiled or lost documentation.
- Delays in communication between the third party and the insurance company.
- Longer processing times, especially if follow-ups are needed.
How to Avoid It:
- Submit Complete Documentation: Ensure all required forms and records are provided upfront, including care provider invoices, proof of ADL assistance, and policyholder information.
- Follow Up Regularly: Respectfully confirm receipt of your documents and ask for progress updates.
- Keep Copies of Everything: Maintain a personal file with duplicates of every submission and record of communication.
SilverSavvy’s Tip:
We’ve worked with families who were frustrated by missing paperwork or slow responses from claims administrators. By proactively tracking submissions and contacting administrators regularly, we help prevent any delays and ensure claims stay on track.
5. Navigating the Claims Process Alone
The Mistake:
Trying to handle the LTCI claims process without guidance often leads to avoidable stress and missed benefits.
How to Avoid It:
- Partner with LTCI specialists, like SilverSavvy, who understand the nuances of claims and can advocate for you.
SilverSavvy’s Tip:
With years of experience helping families navigate LTCI claims, we ensure no detail is overlooked, providing peace of mind during an already challenging time.
Bonus Tip: Be Strategic About Service Days
If your policy uses service days, schedule care strategically to minimize delays. For example, consider daily care even if it’s minimal to ensure days are counted consistently.
Recommended Tools to Navigate the Claims Process
- Care Management Apps (e.g., Carely):
Track care services, ADLs, and documentation in one place. - Licensed Homecare Agencies:
Partnering with experienced providers ensures compliance with your insurance requirements. - LTCI Specialists:
Experts can help demystify policy language and advocate on your behalf.
Conclusion
The LTCI claims process has become more complex with the outsourcing of claims management. While this system helps insurance companies manage high volumes, it also requires policyholders to be extra diligent. By understanding your policy, submitting thorough documentation, and following up consistently, you can avoid common pitfalls and ensure your claim is handled smoothly.
At SilverSavvy, we specialize in guiding families through the complexities of LTCI claims. Whether you’re navigating outsourced systems or understanding your elimination period, we’re here to help.
Contact us today at [email protected] or visit www.silversavvy.com to schedule a complimentary consultation to explore our services. Together, we’ll make the process manageable and ensure you receive the benefits you deserve.