LTCI Claims: How they Work, Tips for Filing, and Advise from Specialists

Purchasing a long term care (LTC) policy is a big investment and an important step in securing a solid retirement plan. When it comes time to go on claim, emotions are high and the expenses can add up quickly, so we’ve compiled some helpful resources including some basic steps in the claims process, tips to help the process go smoothly, and key pieces of advice from our LTC Specialists.

Although the process can vary slightly from carrier to carrier, there are some basic stages which will need to occur. If you or someone you know is ready to make a LTC insurance claim, here’s how a LTCI claim works.

Six basic steps in the claims process:

  • Have documented proof in your medical records that you need help with at least two of six ADLs or have a cognitive impairment
  • Get claim forms from the insurance carrier, fill everything out, gather materials, and submit
  • A caseworker will review and decide if the policyholder meets the eligibility requirements
  • Meet the elimination period of the policy, which is similar to a deductible
  • The carrier will begin paying the claim directly or through reimbursement
  • The claim will be reviewed periodically to make sure the policy holder is still eligible for benefits

Again, these steps can vary slightly, and there may be bumps in the road along the way. Generally speaking the claims department is there to help you, they’ve been through this many times before and they will probably anticipate some of your questions. Here are a few things to remember.

Four tips to help make the claims filing process a bit easier:

  • Gather the policy information before calling – policy number, social security number, basic coverage, claims phone number. Some carriers may require you be the policyholder’s legal representative or power of attorney.
  • Understand how the elimination period works – After a physician confirms a cognitive impairment or inability to do two out of six ADLs, the elimination period begins. The process is much smoother and shorter if this is in the medical records.
  • Contact the LTCI Claims Customer Service Department – You do not need to satisfy the elimination period before initiating a claim. Call immediately to begin the process.
  • Keep your emotions in check – Make a list of questions and be careful about making big decisions while emotions are high. This process can take a while, but it’s worth it in the end.

Our LTC Specialists have decades of experience and have helped many of their clients navigate the claims process smoothly and efficiently.

Five pieces of advice from experienced LTC Specialists

  • “Make sure you have a thorough understanding of what it means to trigger your benefits. Most disappointment and anger comes from clients not understanding this or their agent not explaining it. Also, make sure you have a good relationship with your agent. Your agent can handle the whole process for you taking all the pressure off your children.” – Curt Horowitz, National Sales Manager
  • “Policyholders should consult with their agent for advice on what needs to be documented in their medical records by their physician in order to trigger the policy into paying benefits.” – Cathy Flanagan, Consumer Specialist
  • “Be certain you have a Power of Attorney set up and have at least one or more people designated with the insurance company who can begin the claims process should the policyholder need to begin a claim.” – Dan Payne, Consumer Specialist
  • “Verify with the carrier that all care providers or facilities are eligible for payment in advance of services being performed.” – Bill Wetmore, Consumer Specialist
  • “Double check that your family members or children understand how the policy works. Make sure that you understand you have an elimination period. Have any forms associated with filing a claim ahead of time while you’re healthy so if something were to change you’re prepared in understanding the process.” – Rich Horowitz, Consumer Specialist

Long term care insurance is meant to protect families and retirements, and though the claims process can be stressful, hopefully these tools make it a bit easier. If you or your loved ones would like to learn more or apply for coverage, speak to a specialist today.