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How Can I Get My Long-Term Care Insurance Claim Activated?

Quality long-term care can be expensive, especially in areas with large populations of aging residents. The American Council on Aging states that the average annual cost of a nursing home in Miami ranges from roughly $108,000 for a semi-private room to $130,000 for a private room. Assisted living facilities and in-home care may be slightly less but do not usually offer the same services. Conversely, long-term care for patients with cognitive difficulties is more expensive due to the specialized care needed for such individuals.

Many people purchase long-term care insurance to help offset long-term care expenses. Most people purchase this coverage in their mid-50s to mid-60s, years before they expect to utilize it. Over time, federal and state regulations regarding insurance  – or the terms of the policy itself – may change, creating confusion when the time comes to activate the coverage. This confusion could lead to rejected claims, forcing you to pay more out-of-pocket than necessary. According to https://www.longtermcarelawoffice.com/long-term-care-insurance-claim-activation, when preparing for insurance claim activation, you should thoroughly understand your policy’s terms and conditions and keep all documentation related to your medical needs.

Keep all Documentation Together

To activate your claim, you will need to provide documentation showing that you have fulfilled all of the prerequisite terms as dictated by your policy. Policy terms vary by the insurance company and by state, so make sure you review your policy with your power of attorney and a long-term care insurance attorney. A qualified attorney can review your documents, confirm the step you have completed, and determine any steps that need to be taken. Keep all invoices, letters of power of attorney, and medical records secured with your policy in a weather-proof container.

Make sure your power of attorney knows where to find your documents, and if you have power of attorney for your parents, make sure you know where their documentation is kept.

Activating Your Claim

When you are ready to activate your claim, contact your insurance company and request a claim form online or by phone. If you are calling on someone else’s behalf, you will need the power of attorney documents, the policy number, and proof of the policyholder’s identity. The insurance company will then contact the care providers (whether that is a facility or a home care agency) to obtain information about the policyholder’s physical and mental condition.

Usually, individuals who have difficulty with two of the following six activities of daily living or who display cognitive impairment are considered eligible for claim activation:

  • Bathing
  • Dressing
  • Toilet
  • Transferring
  • Eating
  • Continence

Once the insurance company has determined that the policyholder qualifies, there is usually an “elimination period.” This is a period in which the policyholder is expected to pay out-of-pocket for their care before the insurance policy begins payments. During this time, they (or their power of attorney) must provide invoices to prove that their obligation is being met. The services that qualify under the elimination period can be very confusing, so it is best to carefully review the terms of the elimination period with a long-term care attorney.

Activating your long-term care policy may seem overwhelming, but you and your loved ones can ensure that your long-term care is handled with confidence with planning and guidance.

Christine Crosby

About the author

Christine is the co-founder and editorial director for GRAND Magazine. She is the grandmother of five and great-grandmom (aka Grandmere) to one. She makes her home in St. Petersburg, Florida.

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