Getting your LTC Insurance Claim Paid

The May 2, 2009 issue of Kiplinger's Personal Finance magazine includes an article on the topic of Long-Term Care claims (click here to read: Make Sure Your Insurer Pays Up).

It’s a decent piece of work, and as the author says, "getting a long-term-care claim approved is the easy part." Here I'd like to offer a few observations and pointers based on 20-plus years experience as a Long-Term Care Insurance professional.

Making a claim on your Long-Term Care Insurance (LTC) should be no more difficult or complicated than making a claim on a homeowners, auto or disability insurance and there are many things you can do at claim time to simplify and speed the process.

If you're just now buying LTC insurance, buy from a knowledgeable agent who cares about his or her clients. An agent can be a tremendous help at claim time. The agent should be intimately familiar with your policy and can often help you avoid miscommunications and other problems during what can be a highly emotional time.

At claim time, your first phone call should be to your agent. He or she can often guide you through the claims process and help eliminate needless frustration and delays.

Since many years typically pass between when a policy is purchased and when a claim is made, you likely would benefit from reviewing your policy, paying attention to these points:

Deductible: Review how the deductible, usually called an ‘elimination period’ is covered.

Licensing requirements: Pay attention to the caregiver’s licensing requirements to make sure you maximize the benefits from your policy.

Proof of licensing: Make sure your claim paperwork includes copies of any required proof of licensing, or the claim could be delayed. Call your claims representative with any questions to make certain your claim is not delayed due to insufficient documentation.

Also, pay attention to the process:

• Start a file: Dedicate a spiral bound notebook to the claim. Keep a record of any and all phone conversations with the claims representative, care coordinator and caregivers. Include date, time, who initiated call and who you spoke with. Keeping everything in one place will make it easier if there is a problem.
  
  
• Send all claims forms via return receipt mail so you know when they have been received at the insurance company. Give the insurer several days to process the paperwork before you call and ask for a status. Proof of receipt is important in the event of a claims appeal, since your contract will state the number of days the insurer has to respond to your appeal (day one is the date they receive your paperwork to respond).
  
  
• Keep your policy handy, not in a safe deposit box. Give a complete photocopy of your policy to a close relative or friend in case you are unable to find your policy at claim time.
  
  
• Name at least one person in the third-party notification section of your application. That person will be notified if your policy is ever in danger of lapsing. Whether the danger is from an extended trip, an oversight, or because of a lapse in cognitive ability, this safeguard is designed to make sure your policy is in force at claim time! If you don't name someone during the application process, you can do it any time after the policy is issued.

A report by the National Association of Insurance Commissioners said the Long-Term Care insurance industry has no systemic issue in regards to claims payments. However, there are many things you can do to simplify and speed the process of making a claim.

Long-Term Care doesn't have to be a complicated and unpleasant subject. In fact, taking responsibility for your own health and welfare can help you avoid years of poverty or substandard care. Everyone must have a Long-Term Care plan in place that will fit their lifestyle and budget.

Dorothy McMahon, president of McMahon and Associates in Bloomfield Hills, Michigan, is a specialist offering straight talk on Long-Term Care Insurance. She has brought her program “Speaking from the Heart on Long-Term Care” to professional association and family support group meetings, conferences and neighborhood coffees. Contact her at (248) 844-9787 or LTCINSUSA@AOL.COM to schedule an appointment or a program for your group.

Questions to Ponder When Considering Long-Term Care Insurance

Are you aware that your health insurance or Medicare will not pay for Long-Term Care? Are you aware that Medicaid does not allow you to choose where and how your care will be provided?

What would happen to your health if your spouse developed Alzheimer's Disease and made it impossible for you to sleep? How would you feel if you needed care and the resulting expenses left your spouse impoverished?

Do you really want to place the emotional and physical burden of Long-Term Care on your family and loved ones? Does the idea of being unable to hire help frighten you?

Would your children be able to take care of you?  If so, would they be sufficiently trained to give you adequate care? Which of your children can most afford to quit their job and neglect their own family to care for you? Which of your children is best able to pay for all or part of your care?

Do you think there could be a conflict among your children when they must decide who will be the primary caregiver? If your son must bathe you, how will that affect your relationship with him?

After you have given these questions some serious thought, please feel free to contact me so that we can discuss any additional questions or concerns. You can email me at ltcinsusa@aol.com.

Planning Makes Perfect

Once again we are approaching the holiday season.  What a wonderful time of year to share good times with family and friends, a time to talk about our goals, our dreams, and our plans (or lack of) for the future.

I would like to offer some things to ponder as we spend quality time with those we care about most.  As a wife, mother, grandmother, and a caregiver many times, I suggest parents not only give the following some serious thought but actually have a conversation with family members over the holidays.  Anyone between the ages of 45 and 75 absolutely must address the following:

   1.)   Are you aware that your health insurance or Medicare will not pay for Long-Term Health Care?

   2.)   Are you aware that Medicaid does not allow you to choose where and how your care will be provided?

   3.)   What would happen to your health if your spouse developed Alzheimer's disease and made it impossible for you to sleep?

   4.)   How would you feel  if you needed care and the resulting expense left your spouse impoverished?

   5.)   Do you really want to place the emotional and physical burden of Long-Term Care on your family and loved ones?

   6.)   Does the idea of being unable to hire help frighten you?

   7.)   Would your children be able to take care of you?  If so, would they be sufficiently trained to give you adequate care?

   8.)   Which of your children can most afford to quit their job and neglect their own family to care for you?

   9.)    Which of your children is best able to pay for all or  part of your care?

 10.)   Do you think there could be a conflict among your children when they must decide who will be the primary caregibver?

 11.)   If your son must bathe you, how will that affect your relationship with him?

         
I welcome all responses, questions and inquiries.
Dorothy McMahon

Straight Talk About Long-Term Care

Today 40% Of Caregivers Are Men

Long-Term Care is the type of assistance that a person of any age needs when that person becomes unable to perform basic activities such as bathing, dressing, eating, toileting, continence or transferring.  It is also the best option for a person who needs care bacause of Alzheimer;s disease or any other form of memory loss.

Long-Term Care is NOT nursing home care for the 85 year old.  It's not a place, it is an event!

Some Food For Thought:

1.  Today 43% of people receiving Long-Term Care are not seniors but people between the ages of 18 and 64.

2.  Today 40% of all caregivers are male.

3.  Today 52% of all working males are caregivers for a person over age 18.

Long-Term Care Insurance will help you to:

1.  Protect your retirement savings.  Do you want to pay for care with money from your portfolio or your 401K?

2.  Maintain independence and allow choice as to where you or a family member will receive care.

3.  Avoid physical, financial and emotional stress, whether you become the caregiver or the care recipient.

4.  Pay for better care for a longer period.

Purchasing Long-Term Care Insurance is a decision to keep  yourself (or a loved one) out of a nursing home and from  moving in with your kids.

Think of Long-Term Care Insurance as a pair of shoes.  You purchase them for protection and comfort so you can go the distance in style; without them, you are going nowhere!

I welcome your comments!

Yes, We Are Alone

Well, I guess if we haven't figured it out by now, these last several days have made it even more clear that we are now alone. 

For those of us who have been planning on the government to pick up the tab for our Long-Term Health Care we can be assured that this will not happen.

This is a good time to be thinking of putting a Long-Term Care insurance policy in place so that when our health changes we wil  be in control of our own care.  We will be the ones making the choices of where and what quality of care we receive.

Let's keep in mind as we plan, that 43% of ALL people receiving Long-Term Health Care today are UNDER the age of 65.  Long-Term Care insurance in NOT nursing home insurance for the 85 year old.

If there is a history of heart attack, stroke, MS, Parkinsons Disease, Alzheimer's Disease or any other type of dementia or memory loss we  should be talking to a professional Long-Term Care Insurance Specialist.  Once our health changes we may not be able to buy this important insurance policy at any price.